A Novel Imaging System Distinguishes Neoplastic from Normal Tissue During Resection of Soft Tissue Sarcomas and Mast Cell Tumors in Dogs
A Novel Imaging System Distinguishes Neoplastic from Normal Tissue During Resection of Soft Tissue Sarcomas and Mast Cell Tumors in Dogs
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DOI：
10.1111/vsu.12487
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发表时间：
2016-08-01
影响因子：
1.8
通讯作者：
Berg, John
中科院分区：
文献类型：
--
作者：
DeWitt, Suzanne Bartholf;Eward, William C.;Berg, John
目的：评估一种新型成像系统在犬软组织肉瘤（STS）和肥大细胞瘤（MCT）切除术中术中检测肿瘤床残留癌的能力，以区分肿瘤和正常组织。研究设计：非随机前瞻性临床试验。动物：12只STS犬和7只MCT犬。方法：在肿瘤切除前4 ~ 6小时或24 ~ 26小时分别给犬注射体内蛋白酶激活的荧光显像剂。手术期间，手持式成像设备用于测量切除标本癌变部分内的荧光强度，并确定随后识别癌症的强度阈值。然后对切除标本和肿瘤床内的选定区域进行成像，并从荧光强度是否超过阈值的区域进行活检（n=101）。比较术中荧光和组织学结果。结果：该成像系统在93/101例活检中正确区分癌与正常组织（92%）。以组织学为参照，成像系统在活检中鉴别癌症的灵敏度和特异性分别为92%和92%。有10/19（53%）的狗在注射显像剂后不久出现短暂的面部红斑，静脉注射苯海拉明对这种红斑有反应，但不一致。结论：基于荧光成像系统的犬软组织肉瘤（STS）和肥大细胞瘤（MCT）组织术中鉴别准确度高。该系统有可能帮助外科医生在手术中评估肿瘤切除的充分性，潜在地降低局部肿瘤复发的风险。尽管对抗组胺药有反应，但鉴于该成像系统对狗的潜在益处，需要考虑过敏的风险。
Objective: To assess the ability of a novel imaging system designed for intraoperative detection of residual cancer in tumor beds to distinguish neoplastic from normal tissue in dogs undergoing resection of soft tissue sarcoma (STS) and mast cell tumor (MCT).Study Design: Non-randomized prospective clinical trial.Animals: 12 dogs with STS and 7 dogs with MCT.Methods: A fluorescent imaging agent that is activated by proteases in vivo was administered to the dogs 4-6 or 24-26 hours before tumor resection. During surgery, a handheld imaging device was used to measure fluorescence intensity within the cancerous portion of the resected specimen and determine an intensity threshold for subsequent identification of cancer. Selected areas within the resected specimen and tumor bed were then imaged, and biopsies (n=101) were obtained from areas that did or did not have a fluorescence intensity exceeding the threshold. Results of intraoperative fluorescence and histology were compared.Results: The imaging system correctly distinguished cancer from normal tissue in 93/101 biopsies (92%). Using histology as the reference, the sensitivity and specificity of the imaging system for identification of cancer in biopsies were 92% and 92%, respectively. There were 10/19 (53%) dogs which exhibited transient facial erythema soon after injection of the imaging agent which responded to but was not consistently prevented by intravenous diphenhydramine.Conclusion: A fluorescence-based imaging system designed for intraoperative use can distinguish canine soft tissue sarcoma (STS) and mast cell tumor (MCT) tissue from normal tissue with a high degree of accuracy. The system has potential to assist surgeons in assessing the adequacy of tumor resections during surgery, potentially reducing the risk of local tumor recurrence. Although responsive to antihistamines, the risk of hypersensitivity needs to be considered in light of the potential benefits of this imaging system in dogs.