The Feasibility Of Clinnical Application In The Identification Of Small Liver Lesions By Indocyanine Green Fluorescence Imagining

Objective: In this study,Indocyanine Green(ICG)-mediated near-infrared fluorescence imaging system was used intraoperatively to identify the liver microscopic lesions,especially the microscopic liver cancer lesions,that could not be detected by conventional detection methods,such as CT,ultrasound,MRI,and intraoperative visual observation,touch,or intraoperative ultrasound.To explore whether it is possible to improve the detection rate of micro hepatocellular carcinoma or precancerous lesion of the liver,compare and analyze the factors that may affect the false positive rate,and explore the clinical application value of ICG fluorescence imaging technology in liver cancer lesions,so as to provide ideas and references for early diagnosis and treatment of clinical liver cancer.Methods: A total of 59 patients regardless of age,gender and race who undergo hepatocellular carcinoma resection in Shengjing Hospital from December 2016 to September 2017 were selected.The subjects were small hepatic nodules(0.2-2cm)highlighted and detected by intraoperative fluorescence imaging.ICG was injected intravenously before surgery,ICGR15 value was calculated,and the preoperative infusion time of ICG was recorded(in hours).Immediately after the specimen was isolated,ICG-mediated immunofluorescence detector was used to investigate the excised specimen.At first,the fluorescence imaging patterns of tumor lesions in vitro speciments during hepatectomy were recorded,the presence of any bright fluorescent visible minute lesions(d=0.2-2cm)around the tumor was then detected and recorded as the experimental group after the specimen was isolated after that,non-cancerous liver tissues(d ?1cm)without fluorescence reaction were cut from in vitro specimens at the same time as the control group.Routine pathological examination and GPC3 staining were performed to record the pathological results.The pathological results were positive for liver cancer,metastatic liver cancer,and negative for the rest.Statistical methods were used to analyze the influenceing factors of fluorescence imaging results of hepatocellular carcinoma and peripheral microimaging lesions.P <0.05 was considered statistically significant.Results: After the detection of ICG fluorescence imaging,50 out of 59 pations with HCC were detected,peripheral microimaging lesions with bright fluorescence in vitro specimens of 26 patients were found in the 59 pations.A total of 65 microscopic lesions were found,4of which were pathologically confirmed as hepatocellular carcinoma.Statistical analysis showed that the larger the tumor diameter was,the easier the fluorescence imaging was(p<0.05),and the degree of tumor differentition was significantly correlated with the tumor profile fluorescence imaging mode(p<0.05).No obvious correlation factor has been found for perinocaicinoma fluorescence microlesion imaging.within the detection range,the accuracy rate of ICG fluorescence imaging in detecting the pericancerous microlesion was 34.40%,the false positive rate was68.53%,with an Youden index of 0.3614.Conclusion:1.The better the degree of tumor differentiatuon,the higher the brightness of the tumor profile should be.2.Intraoperative real-time ICG fluorescence imaging technology can detect small liver cancer lesions which was not detected by conventional imaging examination,but the false positive rate is too high,which requiers large sample experiment to further study and solve this problem.