Metastasectomy of Hepatoblastoma Utilizing a Novel Overlay Fluorescence Imaging System
Metastasectomy of Hepatoblastoma Utilizing a Novel Overlay Fluorescence Imaging System
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DOI：
10.1089/lap.2017.0735
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发表时间：
2018-09-01
影响因子：
1.3
通讯作者：
Kuroda, Tatsuo
中科院分区：
文献类型：
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作者：
Yamada, Yohei;Hoshino, Ken;Kuroda, Tatsuo
背景：肝母细胞瘤（HB）的可治愈性在很大程度上取决于根治性手术切除的实现，即使是转移性肿瘤。然而，当通过内窥镜以传统白光模式观察时，转移性肿瘤的延伸通常不清楚。利用吲哚菁绿色（ICG）的成像技术的进步促进了转移性HB的精确切除，这是由于ICG在此类病变中比在其他正常组织中保留更长时间。案例：我们使用了装有PINPOINT系统的内窥镜（NOVADAQ Technologies，Inc.，安大略，加拿大），其允许在白光模式和近红外模式之间具有相同焦距范围的实时叠加可视化。已经摄取ICG的转移性HB被可视化为叠加在高清晰度白光图像上的绿色区域。一名19岁女性，2年前因不能切除的HB接受肝移植，发现横膈膜和胸膜有转移。术前磁共振成像显示右胸膜转移性HB从肋骨和膈肌延伸。PINPOINT系统比普通白光模式更清晰地显示了转移瘤的边缘。利用重叠图像在实时引导下成功整块切除肿瘤。手术后12个月内，甲胎蛋白水平已恢复正常，并保持在正常范围内。结论：新型的ICG重叠成像技术可以实现转移性HB的实时精确切除。
Background: The curability of hepatoblastoma (HB) largely depends on the achievement of radical surgical resection, even for metastatic tumors. However, the extension of the metastatic tumor when viewed through an endoscope with the conventional white-light mode is often unclear. Advancements in imaging technology utilizing indocyanine green (ICG) have facilitated precise resection of metastatic HBs, owing to the longer retention of ICG in such lesions than in other normal tissues. Case: We utilized an endoscope loaded with the PINPOINT system (NOVADAQ Technologies, Inc., Ontario, Canada), which allows for real-time overlay visualization with the same focal range between the white-light mode and near-infrared mode. Metastatic HBs that have taken up ICG are visualized as an area of green color superimposed on a high-definition white-light image. A 19-year-old female who underwent liver transplantation for an unresectable HB 2 years earlier was noted to have metastases on the diaphragm and the pleura. Preoperative magnetic resonance imaging showed metastatic HBs on the right pleura extending from the ribs and the diaphragm. The margin of the metastatic tumor was more sharply demarcated by the PINPOINT system than that detected in the normal white-light mode. The tumor was successfully resected en bloc with real-time guidance utilizing the overlay image. The alphafetoprotein levels were normalized and have remained within normal limits in the 12 months since the operation. Conclusion: Novel overlay imaging technology with ICG makes it possible to achieve real-time precise resection of metastatic HBs.