Nasal endoscopic indocyanine green fluorescence imaging guided surgery for recurrent nasopharyngeal carcinoma.

Abstract

Introduction: To evaluate the feasibility and diagnostic value of indocyanine green (ICG) fluorescence imaging in the surgical treatment of recurrent nasopharyngeal carcinoma (rNPC).

Methodology: A retrospective analysis was conducted on clinical data of patients who presented to our department between January 2024 and January 2026, and underwent endoscopic surgery guided by ICG fluorescence imaging system intraoperatively. These patients had previously received radiotherapy for NPC and were found to have suspected recurrence during follow-up examinations. ICG fluorescent agent was administered preoperatively or intraoperatively, and tumours were resected under real-time fluorescence endoscopic monitoring. The fluorescence imaging effects of the tumours and the pathological results of fluorescence-positive lesions were recorded and analysed.

Results: This study included 82 patients with suspected recurrence on preoperative evaluation who underwent ICG fluorescence imaging. Patients were stratified based on pathological findings into tumour group (n=46) and non-tumour group (n=36). Statistical analysis demonstrated a significant correlation between ICG fluorescence localization and pathological diagnosis. The sensitivity of ICG for tumour detection was 89.1%, specificity was 72.2%, positive predictive value was 80.4%, negative predictive value was 83.9%, and overall accuracy was 81.7%. ROC curve analysis yielded an area under the curve (AUC) of 0.88 for ICG fluorescence in distinguishing tumours.

Conclusions: This study is the first to systematically validate the feasibility and diagnostic value of ICG fluorescence imaging in the complex clinical scenario of rNPC surgery, providing a new tool to improve the radicality and safety of surgery for rNPC.