| Objective:This study aims to evaluate the clinical application value of indocyanine green-fluorescence imaging in the surgical of liver cancer.Methods:The prospective study was adopted.The clinicopathologic data of 36patiens with liver tumors who underwent surgical resection at the Affiliated Hospital,Southwest Medical University from July 2017 to January 2018 were collected and All patients underwent a 64-row enhanced CT scan before surgery,and the character,location and metastasis focuses of liver tumor were preliminarily determined.26 of the 36 patients were preliminary considered primary hepatic carcinoma,there were 23 male and 3 female patients with average age of(53±10)years(range 29-74 years);10 considered benign lesion,there were 6 male and 4 female patients with average age of(51±10)years(range 38-66years).Indocyanine green(0.5mg/kg)was injected intravenously of 72 hours prior to surgery.A ultrasonic and near-infrared light camera system was used to detect the liver surfaves before resection,and to plan resection line and surgical specimens.After complete removal of the tumor lesions,the remnant liver and isolated tumor was redetected,especially the surgical margin.All suspected foci were removed and sent for pathological examination.The index were recorded during surgery and removal:(1)The fluorescence imaging characteristics of the tumor before removal compared with benign lesions.(2)26 patients with primary livercallcer were enrolled.Enro-llced computed tomography(CT)scan were perfornled prior to surgery.Upon laparotomy,surgeons located the tumor and searched for new lesions with fluorescence imaging,intraoperative ultrasound,and recorded the detection results.The diagnositic sensitivitv and specificity of tumor foci were compared between preoperative CT,fluorescence imaging and intraoperative ultrasound.(4)The fluorescence imaging characteristics of new lesions and surgical margin.(5)The fluorescence imaging characteristics of isolated tumor specimens.(6)By ImageJ,fluorescence intensity was determined.Finally,all data were analyzed by routine pathological and preoperative examination.Results:(1)Among the 36 patients,49 lesions were found.28 of the 49 lesions were malignant lesions:26 hepatocellular carcinoma,1 cholangiocarcinoma and 1 adenocarcinoma,21 were benign lesions:6 liver abscess,1 angiomy-olipoma,2 necrosis with fibrosis,1 focal nodular hyperplasia,6 hemangiomas,1 lymph node hyperplasia,1 cirrhotic nodule,3 normal liver.The fluorescence intensity of benign lesions and malignant lesions was different,and the fluorescence intensity of malignant lesions was higher than that of benign lesions(67.86±49.92>21.20±25.05,t=-3.851,P<0.001).(2)22 of the 26 primary tumor lesions were detected by fluorescence imaging system,when 26 isolated tumor were cuted,all tumor lesions were detected by fluorescence imaging system.However,10 benign lesions were not detected before removal and cuted.(3)The differential diagnosis of malignant and benign tumors:the result showed that the veracity and positive predictive value of tumor lesion detection with CT were higher than fluorescence imaging system(P<0.001),There is no difference in sensitivity.the sensitivity(P=0.011,P<0.05),positive predictive value(P=0.0015,P<0.05),and negative predictive value(P=0.020)of tumor lesion detection with IOUS were lower than fluorescence imaging system(P<0.05).(4)7 new suspicious lesions were detected in the residual liver,with an average depth of 2.5mm(range,0-10mm)and an average diameter of 13.6mm(rang,7-25mm).pathological examination showed that cancer(n=2)(2/7,29%),proliferation of fibrous tissue(n=1)(1/7,14%),cirrhotic nodule(n=1,14%),normal liver tissue(n=3)(3/7,43%).(5)19 of the 28 isolated malignant tumors acquired the immunohistochemical date,3 well differentiated tumors showed total fluoresce-nt type,10 of 13 moderate-differentiated tumors showed partial fluorescent type and 2 of 13 moderate-differentiated tumors showed total fluorescent type,1 of 13 moderate-differentiated tumors showed rim fluorescent type,2 poor differentiated tumors showed rim fluorecent type.(6)Determine the cutting edge:22 of the 26 surgical margins of tumor lesions were detected by fluorescence imaging system,pathological examination confirmed that all patients were R0 margin.(7)The correlation between the levels of HBsAg,HBV-DNA,AFP,P53,KI-67 and the fluorescence intensity:this is negative relations between fluorescence intensity and KI-67(r_s=-0.558,P=0.005,P<0.050),and no correlation among HBsAg,HBV- DNA,AFP,P53(P>0.05).(8)The extrahepatic peritoneal metastasis can also was deteceted by fluorescence imaging system.Conclusion:(1)Indocyanine green-fluorescence imaging has important value in locating carcinoma,detecting liver metastases,planning resection line and real-time surgical navigation in liver cancer surgery.(2)Indocyanine greenfluorescence imaging can preliminary estimate liver differentiated degree by fluorescent type.(3)Fluorescence intensity was associated with kI-67.(4)Indocyanine green fluorescence imaging technology can help to revise the surgical method and liver cancer staging. |
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