Fluorescent liver imaging guides pancreatic cancer surgery
MedWire News: Realtime near-infrared camera imaging can detect hepatic micrometastases in patients with pancreatic cancer before they are visible radiographically, research shows.
The presence of liver micrometastases can be used to determine the appropriate surgical procedure, explain Naoyuki Yokoyama (Niigata City General Hospital, Japan) and co-authors in Cancer.
"Pancreatic cancer with hepatic micrometastases does not warrant radical resection," they say.
The team treated 49 patients undergoing pancreatic cancer surgery with indocyanine green, and scanned their livers during surgery with a near-infrared camera. Abnormal fluorescent foci were examined using frozen-section histology.
The patients had previously undergone computed tomography (CT) or magnetic resonance imaging and no liver metastases were detected. However, 13 patients had abnormal fluorescent foci that were at least 1.5 mm in diameter in the absence of tumors, and histology confirmed the presence of micrometastases in eight patients.
Patients with micrometastatic disease were classed as having unresectable disease, and underwent palliative surgery and chemotherapy.
CT imaging 6 months later revealed that 88% of the patients with micrometastases at the time of surgery had overt hepatic metastatic disease compared with just 10% of those without fluorescent foci during surgery.
Without considering histologic results, abnormal fluorescence had positive and negative predictive values of 77% and 97% for the likelihood of hepatic relapse within 6 months of surgery, report Yokoyama et al.
"We believe that the [indocyanine green]-fluorescent imaging technique is feasible and fulfills the demand of clinical oncologists for cancer staging during pancreatic surgery," the researchers conclude.
They therefore recommend: "The hepatic micrometastases confirmed by this technique should be treated in the same manner as evident hepatic metastases from pancreatic cancer."
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By Lynda Williams