吲哚菁绿标记荧光成像技术在骨与软组织肿瘤切除手术中的辅助作用

Application of indocyanine green-based fluorescence imaging in bone and soft tissue tumors

目的探讨吲哚菁绿(indocyanine green,ICG)荧光成像在骨与软组织肿瘤切除手术中的作用与临床价值。方法回顾性分析38例采用ICG标记近红外(near-infrared,NIR)荧光成像辅助手术的骨与软组织肿瘤患者,男17例、女21例,年龄(36±21)岁(范围5~75岁)。手术前1 d静脉滴注2 mg/kg剂量ICG,术中行NIR成像确认肿瘤荧光信号;肿瘤切除后,对肿瘤床进行NIR成像检测荧光残留灶;进一步切除荧光残留病灶送病理学检测,确认是否含有肿瘤组织。对荧光图像进行事后分析,计算肿瘤染色率及信噪比,并分析其影响因素。结果38例患者中34例患者肿瘤成功被ICG染色,总体染色率为90%。不同病理类型、良性或恶性肿瘤、是否接受新辅助化疗、术前不同ICG给药时间组肿瘤染色率的差异无统计学意义(P>0.05)。34例肿瘤成功染色患者的信噪比为2.9(2.3,5.7)。不同病理类型、良性或恶性肿瘤、是否接受新辅助化疗、术前不同ICG给药时间、骨巨细胞瘤患者术前地舒单抗不同用药次数以及肿瘤对新辅助化疗反应好坏患者信噪比的差异无统计学意义(P>0.05)。在肿瘤切除后术中通过荧光引导共送检有荧光残留信号的组织块57块,其中30块病理检查证实含有残余肿瘤病灶,总体准确度为53%。分块切除术的准确度为71%,明显高于整块切除术的16%(χ^(2)=15.51,P=0.000)。结论ICG标记的NIR荧光成像对骨与软组织肿瘤的染色率较高,染色效果稳定,不易被外部因素影响,可用于术中临床隐匿残留肿瘤病灶的检测,在分块切除术中的检测准确度较整块切除术更高。

Objective To explore the role and value of indocyanine green(ICG)fluorescence imaging in the surgery of bone and soft tissue tumors.Methods A total of 38 patients with bone and soft tissue tumors,including 17 males and 21 females,aged 36±21 years(range 5-75 years),who underwent resection with application of ICG-based NIR imaging were retrospectively analyzed.ICG was intravenously administrated at a dose of 2 mg/kg on the day before surgery.Intraoperative NIR imaging was performed to confirm the tumor fluorescence and to detect residual tumor after tumor resection.The NIR imaging was post hoc analyzed to explore the influence factor of tumor stain rate and SBR value.Results Tumor staining with ICG was successful in 34 of the 38 patients,with an overall staining rate of 90%.The ICG tumor stain rate was not influenced by different pathology types,malignant or benign pathology,the reception of neoadjuvant chemotherapies or not,and the length of time between drug administration and surgery(P>0.05).The median SBR of 34 patients with successful tumor staining was 2.9(2.3,5.7).Different pathological types,malignant or benign pathology,whether to receive neoadjuvant chemotherapy,preoperative ICG administration time,preoperative dose of denosumab administration in giant cell tumor of bone patients and tumor response to neoadjuvant chemotherapy had no significant effects on SBR(P>0.05).After tumor resection,a total of 57 pieces of tissue with residual fluorescence signals were detected and resected under the fluorescence guidance,30 of which were pathologically confirmed to contain residual tumor lesions,with an overall accuracy of 53%.The accuracy of intralesional resection was significantly higher than that of en bloc resection(71%vs.16%,χ^(2)=15.51,P=0.000).Conclusion A high percentage of bone and soft tissue tumors can be stained with ICG.The tumor stain of ICG was stable and not easily influenced by external factors.This technique was useful to detect residual tumors,especially after piecemeal resection.