Near-infrared fluorescence-guided resection of colorectal liver metastases.
Near-infrared fluorescence-guided resection of colorectal liver metastases.
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DOI：
10.1002/cncr.28203
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发表时间：
2013-09-15
期刊：
影响因子：
6.2
通讯作者：
Vahrmeijer, Alexander L.
中科院分区：
文献类型：
--
作者：
van der Vorst, Joost R.;Schaafsma, Boudewijn E.;Hutteman, Merlijn;Verbeek, Floris P. R.;Liefers, Gerrit-Jan;Hartgrink, Henk H.;Smit, Vincent T. H. B. M.;Lowik, Clemens W. G. M.;van de Velde, Cornelis J. H.;Frangioni, John V.;Vahrmeijer, Alexander L.
肿瘤外科手术的基本原则是完全切除恶性细胞。然而，在手术中使用传统技术往往很难发现小肿瘤。我们的目的是确定光学成像，使用一种已经批准用于其他适应症的造影剂，是否可以改善肝转移切除术的疗效，优化剂量和时间，并确定造影剂积累的机制。我们利用近红外（NIR）光的高组织穿透性，使用FLARE™图像引导手术系统和近红外荧光靛绿（ICG），在40例接受肝切除术的结直肠癌转移患者的临床试验中。采用近红外荧光成像技术，共发现71例位于肝包膜下< 6.2 mm的浅表结直肠肝转移灶并予以切除。中位肿瘤与肝脏之比（TLR）为7.0（范围1.9-18.7），时间点或剂量之间无显著差异。ICG荧光在肿瘤周围可见一个边缘，我们发现这是被肿瘤压缩的ck7阳性肝细胞周围的包裹。重要的是，在40例患者中有5例（12.5%,95% CI: 5.0-26.6），使用近红外荧光检测到额外的小且位于表面的病变，否则术前计算机断层扫描（CT），术中超声（IOUS），目视检查和触诊无法检测到。我们的结论是，近红外荧光成像，即使使用非靶向的，临床可用的近红外荧光团，也是对传统成像的补充，能够通过其他方式识别遗漏的病变。
The fundamental principle of oncologic surgery is the complete resection of malignant cells. However, small tumors are often difficult to find during surgery using conventional techniques. Our objectives were to determine if optical imaging, using a contrast agent already approved for other indications, could improve hepatic metastasectomy with curative intent, to optimize dose and timing, and to determine the mechanism of contrast agent accumulation. We exploited the high tissue penetration of near-infrared (NIR) light using the FLARE™ image-guided surgery system and the NIR fluorophore indocyanine green (ICG) in a clinical trial of 40 patients undergoing hepatic resection for colorectal cancer metastases. A total of 71 superficially located (< 6.2 mm beneath the liver capsule) colorectal liver metastases were identified and resected using NIR fluorescence imaging. Median tumor-to-liver ratio (TLR) was 7.0 (range 1.9–18.7) and no significant differences between time-points or doses were found. ICG fluorescence was seen as a rim around the tumor, which we show to be entrapment around CK7-positive hepatocytes compressed by the tumor. Importantly, in 5 of 40 patients (12.5%, 95% CI: 5.0–26.6), additional small and superficially located lesions were detected using NIR fluorescence, and were otherwise undetectable by preoperative computed tomography (CT), intraoperative ultrasound (IOUS), visual inspection, and palpation. We conclude that NIR fluorescence imaging, even when utilizing a non-targeted, clinically available NIR fluorophore, is complementary to conventional imaging and able to identify missed lesions by other modalities.
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