PDF(Pubmed)
Abstract：
BACKGROUND: Intraoperative indocyanine green (ICG) fluorescence imaging has been shown to be a new and innovative way to illustrate the optimal resection margin in hepatectomy for hepatocellular carcinoma. This study investigated its accuracy in resection margin determination by looking into the correlation of ICG intensity gradients with pathological examination results of resected specimens.
METHODS: This was a prospective, single-center, non-randomized controlled study. Patients who had liver tumors indicating liver resection were recruited. The hypothesis was that the use of intraoperative near-infrared/ICG fluorescence imaging would be a promising guiding tool for removing hepatocellular carcinoma with a better resection margin. Patients were given ICG (0.25 mg/kg) 1 day before operation. Resected specimens were inspected under a fluorescent imaging system. Biopsies were taken from tumors and normal tissue. Color signals obtained from ICG fluorescence imaging were compared with biopsies for analysis.
RESULTS: Twenty-two patients were recruited for study. The median size of their tumors was 2.25 cm. One patient had resection margin involvement. Under ICG fluorescence, the tumors typically lighted up as yellow color, wrapped by a zone of green color. Tumors of 17 patients (77.3%) displayed yellow color and were confirmed malignancy, while tumors of 12 patients (54.5%) displayed green color and were confirmed malignancy. Receiver operating characteristic curve was used to measure the sensitivity and specificity of the green color to look for a clear resection margin. The area under the curve was 85.3% (p = 0.019, 95% confidence interval 0.696-1.000), with a sensitivity of 0.706 and specificity of 1.000.
CONCLUSIONS: The use of ICG fluorescence can be helpful in determining resection margins. Resection of tumor should include complete resection of the green zone shown in the fluorescence image.
METHODS: This was a prospective, single-center, non-randomized controlled study. Patients who had liver tumors indicating liver resection were recruited. The hypothesis was that the use of intraoperative near-infrared/ICG fluorescence imaging would be a promising guiding tool for removing hepatocellular carcinoma with a better resection margin. Patients were given ICG (0.25 mg/kg) 1 day before operation. Resected specimens were inspected under a fluorescent imaging system. Biopsies were taken from tumors and normal tissue. Color signals obtained from ICG fluorescence imaging were compared with biopsies for analysis.
RESULTS: Twenty-two patients were recruited for study. The median size of their tumors was 2.25 cm. One patient had resection margin involvement. Under ICG fluorescence, the tumors typically lighted up as yellow color, wrapped by a zone of green color. Tumors of 17 patients (77.3%) displayed yellow color and were confirmed malignancy, while tumors of 12 patients (54.5%) displayed green color and were confirmed malignancy. Receiver operating characteristic curve was used to measure the sensitivity and specificity of the green color to look for a clear resection margin. The area under the curve was 85.3% (p = 0.019, 95% confidence interval 0.696-1.000), with a sensitivity of 0.706 and specificity of 1.000.
CONCLUSIONS: The use of ICG fluorescence can be helpful in determining resection margins. Resection of tumor should include complete resection of the green zone shown in the fluorescence image.
摘要：
背景：术中吲哚菁绿（ICG）荧光成像已被证明是一种新的创新方法，可以说明肝细胞癌肝切除术中的最佳切除边缘。这项研究通过研究ICG强度梯度与切除标本的病理检查结果的相关性，调查了其在切除边缘确定中的准确性。
方法：这是一个前瞻性的，单中心,非随机对照研究。招募具有指示肝切除的肝肿瘤的患者。假设是，使用术中近红外/ICG荧光成像将是一个有希望的指导工具，以更好的切除边缘切除肝细胞癌。术前1天给予ICG(0.25mg/kg)。在荧光成像系统下检查切除的样本。活检取自肿瘤和正常组织。将从ICG荧光成像获得的颜色信号与活检进行比较以进行分析。
结果：招募了22名患者进行研究。其肿瘤的中值大小为2.25cm。一名患者有切除边缘受累。在ICG荧光下，肿瘤通常呈黄色，被绿色的区域包裹着。17例患者（77.3%）肿瘤呈黄色，确诊为恶性肿瘤，而12例患者（54.5%）的肿瘤显示绿色，并被证实为恶性肿瘤。使用受试者工作特征曲线来测量绿色的敏感性和特异性，以寻找清晰的切除边缘。曲线下面积为85.3%(p=0.019,95%置信区间0.696-1.000),灵敏度为0.706，特异性为1.000。
结论：使用ICG荧光有助于确定切除边缘。肿瘤切除应包括完全切除荧光图像中显示的绿色区域。
方法：这是一个前瞻性的，单中心,非随机对照研究。招募具有指示肝切除的肝肿瘤的患者。假设是，使用术中近红外/ICG荧光成像将是一个有希望的指导工具，以更好的切除边缘切除肝细胞癌。术前1天给予ICG(0.25mg/kg)。在荧光成像系统下检查切除的样本。活检取自肿瘤和正常组织。将从ICG荧光成像获得的颜色信号与活检进行比较以进行分析。
结果：招募了22名患者进行研究。其肿瘤的中值大小为2.25cm。一名患者有切除边缘受累。在ICG荧光下，肿瘤通常呈黄色，被绿色的区域包裹着。17例患者（77.3%）肿瘤呈黄色，确诊为恶性肿瘤，而12例患者（54.5%）的肿瘤显示绿色，并被证实为恶性肿瘤。使用受试者工作特征曲线来测量绿色的敏感性和特异性，以寻找清晰的切除边缘。曲线下面积为85.3%(p=0.019,95%置信区间0.696-1.000),灵敏度为0.706，特异性为1.000。
结论：使用ICG荧光有助于确定切除边缘。肿瘤切除应包括完全切除荧光图像中显示的绿色区域。
