Real-Time Identification of Liver Cancers by Using Indocyanine Green Fluorescent Imaging

Real-Time Identification of Liver Cancers by Using Indocyanine Green Fluorescent Imaging
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DOI：
10.1002/cncr.24291
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发表时间：
2009-06-01
期刊：
CANCER
影响因子：
6.2
通讯作者：
Kokudo, Norihiro
Kokudo, Norihiro
中科院分区：
医学1区
文献类型：
--
作者：
Ishizawa, Takeaki;Fukushima, Noriyoshi;Kokudo, Norihiro

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背景：我们在手术中识别小肝癌时经常遇到困难。使用吲哚菁绿色（ICG）的荧光成像具有通过可视化在癌组织和被肿瘤压迫的非癌肝组织中的ICG的无序胆汁排泄来检测肝癌的潜力。方法：对37例肝细胞癌（HCC）和12例结直肠癌（CRC）转移患者在肝切除术前静脉注射ICG进行常规肝功能检查。手术标本进行了研究，使用近红外光摄像系统。在49名受试者中，在研究后期检查的26名患者（20名HCC患者和6名转移患者）在切除前接受了肝脏表面的ICG荧光成像。结果：ICG荧光成像识别了手术标本中所有经显微镜证实的HCC（n=63）和CRC转移（n=28）。在63例HCC中，8例（13%，包括5例早期HCC）除非通过ICG荧光成像观察，否则大体上不明显。在荧光病变中发现5个假阳性结节（4个大的再生结节和1个胆管增生）。高分化肝癌表现为均匀的荧光病灶，病灶与肝脏的对比度高于中分化或低分化肝癌（162.6 [71.1-218.2]/像素vs 67.7 [-6.3-211.2]/像素，P
BACKGROUND: We have often encountered difficulties in identifying small liver cancers during surgery. Fluorescent imaging using indocyanine green (ICG) has the potential to detect liver cancers through the visualization of the disordered biliary excretion of ICG in cancer tissues and noncancerous liver tissues compressed by the tumor. METHODS: ICG had been intravenously injected for a routine liver function test in 37 patients with hepatocellular carcinoma (HCC) and 12 patients with metastasis of colorectal carcinoma (CRC) before liver resection. Surgical specimens were investigated using a near-infrared light camera system. Among the 49 subjects, the 26 patients examined during the latter period of the study (20 with HCC and 6 with metastasis) underwent ICG-fluorescent imaging of the liver surfaces before resection. RESULTS: ICG-fluorescent imaging identified all of the microscopically confirmed HCCs (n=63) and CRC metastases (n=28) in surgical specimens. Among the 63 HCCs, 8 tumors (13%, including 5 early HCCs) were not evident grossly unless observed by ICG-fluorescent imaging. Five false-positive nodules (4 large regenerative nodules and 1 bile duct proliferation) were identified among the fluorescent lesions. Well-differentiated HCCs appeared as uniformly fluorescing lesions with higher lesion-to-liver contrast than that of moderately or poorly differentiated HCCs (162.6 [71.1-218.2] per pixel vs 67.7 [-6.3-211.2] per pixel, P