Real-time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging Preliminary results of a prospective study
Real-time detection of hepatic micrometastases from pancreatic cancer by intraoperative fluorescence imaging Preliminary results of a prospective study
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DOI：
10.1002/cncr.26594
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发表时间：
2012-06-01
期刊：
影响因子：
6.2
通讯作者：
Katayanagi, Norio
中科院分区：
文献类型：
--
作者：
Yokoyama, Naoyuki;Otani, Tetsuya;Katayanagi, Norio
背景：最近，一种高灵敏度的荧光成像技术被开发用于实时识别肝脏肿瘤。作者将该程序应用于术中检测胰腺癌的影像学隐匿性肝微转移。方法：对49例接受手术干预的胰腺癌患者进行了检查。术前临床图像未显示任何肝转移。手术前一天，静脉注射吲哚菁绿色。术中用近红外线摄像系统观察肝脏，冰冻切片组织学检查异常荧光灶。肝微转移的患者被判定为不可切除的疾病，仅接受姑息性手术，然后使用吉西他滨进行全身化疗。结果：13例患者肝脏荧光最大直径至少为1.5mm，无明显肿瘤。其中，组织学检查证实在49例患者（16%）的8微转移。所有肝微转移患者均具有临床T3或T4疾病和高血清CA 19 -9水平（P = 0.042）。在术后6个月内获得的随访计算机断层扫描图像上，有肝微转移的患者（8例患者中的7例; 88%）比无肝微转移的患者（41例患者中的4例; 10%; P <0.001）更频繁地表现出明显的肝转移。不考虑组织学证实，异常荧光对6个月内肝脏复发表现的阳性预测值为77%（13例患者中的10例），阴性预测值为97%（36例患者中的35例）。结论：吲哚青绿荧光显像可在术中发现胰腺癌肝微转移。肝微转移似乎具有与明显远处转移相同的不良临床影响。癌症2011年。(c)2011年美国癌症协会
BACKGROUND: Recently, a highly sensitive fluorescent imaging technique was developed for the real-time identification of hepatic tumors. The authors applied this procedure for the intraoperative detection of radiographically occult hepatic micrometastases from pancreatic cancer. METHODS: Forty-nine consecutive patients with pancreatic cancer who underwent surgical intervention were examined. Preoperative clinical images had not revealed any hepatic metastases. On the day before surgery, indocyanine green was injected intravenously. During the operation, the liver was observed with a near-infrared camera system, and abnormal fluorescent foci were examined by frozen-section histology. The patients with hepatic micrometastases were judged to have unresectable disease and underwent only palliative surgery followed by systemic chemotherapy using gemcitabine. RESULTS: Abnormal hepatic fluorescence at least 1.5 mm in greatest dimension without any apparent tumor was observed in 13 patients. Among them, histologic examination confirmed micrometastases in 8 of 49 patients (16%). All patients with hepatic micrometastases had clinical T3 or T4 disease and high serum CA19-9 levels (P = .042). On follow-up computed tomography images that were obtained within 6 months after surgery, the patients with hepatic micrometastases manifested hepatic overt metastases (7 of 8 patients; 88%) more frequently than the patients without hepatic micrometastases (4 of 41 patients; 10%; P < .001). Regardless of histologic confirmation, the positive predictive value of abnormal fluorescence for the manifestation of hepatic relapse within 6 months was 77% (10 of 13 patients), and the negative predictive value was 97% (35 of 36 patients). CONCLUSIONS: Indocyanine green-fluorescent imaging can detect hepatic micrometastases of pancreatic cancer during surgery. The hepatic micrometastases seem to have an adverse clinical impact identical to that of evident distant metastases. Cancer 2011. (c) 2011 American Cancer Society.