Correlation Between Indocyanine Green Fluorescence Patterns and Grade of Differentiation of Hepatocellular Carcinoma: A Western Prospective Cohort Study.

IF 1.2 4区 医学 Q3 SURGERY
Surgical Innovation Pub Date : 2023-12-01 Epub Date: 2023-02-25 DOI:10.1177/15533506231157171
Gaetano Piccolo, Matteo Barabino, Roberto Santambrogio, Francesca Lecchi, Giulio Di Gioia, Enrico Opocher, Paolo Pietro Bianchi
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引用次数: 0

Abstract

Background. Most of the available evidence on the use of indocyanine green (ICG) fluorescence in clinical practice consists of articles published by surgeons of the Asian-Pacific area. We performed a prospective cohort study to assess the patterns of ICG fluorescence in Western hepatocellular carcinoma (HCC) counterparts.Methods. From April 2019 to January 2022, a total of 31 consecutive patients who underwent laparoscopic liver resection (LLR) for superficial HCC were enrolled in this prospective study. All patients underwent laparoscopic staging with both laparoscopic ultrasound (LUS) and ICG fluorescence imaging.Results. A total of 38 hepatocellular carcinomas (HCCs) were enrolled: 23 superficial (surfacing at the liver's Glissonian capsule), 5 exophytic, 5 shallow (<8 mm from the hepatic surface) and 5 deep (>10 mm from the hepatic surface). The detection rate with preoperative imaging (abdominal CT/MRI), LUS, ICG fluorescence and combined modalities (ICG and LUS) was 97.4%, 94.9%, 89.7% and 100%, respectively. The five deep seated lesions underwent ultrasound-guided laparoscopic thermal ablation. The other 33 HCCs were treated with minimally invasive liver resection. Intraoperative ultrasound patterns were registered for each single nodule resected. The ICG fluorescence pattern was classified in two types: total fluorescence (all the tumoral tissue showed strong and homogeneous fluorescence), n = 9/33 (27.3%), and non-total fluorescence (partial and rim fluorescence), n = 24/33 (72.7%). There was a statistical correlation between ICG patterns and grade of differentiation. Almost all lesions with uniform fluorescence pattern were well-differentiated HCCs (G1-G2), while partial and rim-type fluorescence pattern were more common among moderately and poorly differentiated HCCs (G3-G4) (88.9% vs 11.1%, 37.5% vs 62.5%, P = .025, respectively).Conclusions. ICG fluorescence imaging could be used to identify early the grade of HCC, ie intraoperatively, thus influencing the intraoperative treatment.

吲哚菁绿荧光模式与肝细胞癌分化等级的相关性:一项西方前瞻性队列研究
背景。关于在临床实践中使用吲哚菁绿(ICG)荧光的现有证据大多是亚太地区外科医生发表的文章。我们进行了一项前瞻性队列研究,以评估西方肝细胞癌(HCC)同行的 ICG 荧光模式。从 2019 年 4 月到 2022 年 1 月,共有 31 例因浅表 HCC 而接受腹腔镜肝切除术(LLR)的连续患者被纳入这项前瞻性研究。所有患者均通过腹腔镜超声(LUS)和ICG荧光成像进行了腹腔镜分期。共纳入38例肝细胞癌(HCC):23例表浅型(浮现于肝脏的格利松囊)、5例赘生物、5例浅表型(距肝脏表面10毫米)。术前成像(腹部 CT/MRI)、LUS、ICG 荧光和联合模式(ICG 和 LUS)的检出率分别为 97.4%、94.9%、89.7% 和 100%。五例深部病灶接受了超声引导下的腹腔镜热消融术。其他 33 个 HCC 采用微创肝切除术治疗。对切除的每个单个结节进行了术中超声模式登记。ICG荧光模式分为两种:全荧光(所有肿瘤组织都显示出均匀的强荧光),n = 9/33(27.3%);非全荧光(部分和边缘荧光),n = 24/33(72.7%)。ICG 模式与分化等级之间存在统计学相关性。几乎所有具有均匀荧光模式的病变都是分化良好的HCC(G1-G2),而部分和边缘型荧光模式在中度和分化较差的HCC(G3-G4)中更为常见(分别为88.9% vs 11.1%、37.5% vs 62.5%,P = .025)。ICG荧光成像可用于早期识别HCC的分级,即术中分级,从而影响术中治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Surgical Innovation
Surgical Innovation 医学-外科
CiteScore
2.90
自引率
0.00%
发文量
72
审稿时长
6-12 weeks
期刊介绍: Surgical Innovation (SRI) is a peer-reviewed bi-monthly journal focusing on minimally invasive surgical techniques, new instruments such as laparoscopes and endoscopes, and new technologies. SRI prepares surgeons to think and work in "the operating room of the future" through learning new techniques, understanding and adapting to new technologies, maintaining surgical competencies, and applying surgical outcomes data to their practices. This journal is a member of the Committee on Publication Ethics (COPE).
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