Objective: Local recurrence is the main cause of treatment failure in patients with oral squamous cell carcinoma (OSCC). This study was proposed to investigate the feasibility of near infrared fluorescence (NIF) via indocyanine green (ICG) for monitoring surgical marginal in operation for OSCC patients. Methods: In 35 patients with OSCC treated surgically in the Department of Oral and Maxillofacial Surgery, Nanjing University School of Medicine, from January 2019 to June 2020, ICG (0.75 mg/kg) was administered intravenously via elbow vein at (12±1) hours before surgery, and NIF was performed intraoperatively on the surgical field and the cut edge of the surgically excised specimen, and fluorescence intensity was measured for OSCC tissue and normal oral mucosa, abnormal fluorescence signals were taken and subjected to rapid cryopathological examination. Correlation between NIF tumor boundary grading and pathological tumor boundary grading was analyzed by Spearman correlation analysis. Results: Clear ICG NIF was obtained for tumor lesions in all 35 patients, with a positive rate of 100%. The fluorescence intensity of OSCC tissue was (412.73±146.56) au, which was higher than that of normal oral mucosa tissue [(279.38±82.56) au, P<0.01]. Abnormal fluorescence signals were detected at the tumor bed and the cut edge of the surgical resection specimen in 4 patients, of which 2 cases were pathologically confirmed as cancer cell residue and 2 cases as inflammatory cell infiltration. The rate of positive detection of cut margins using ICG NIF technique in OSCC was 5.7% (2/35). Twenty of the 35 OSCC patients had grade 1, 11 of grade 2, and 4 of grade 3 tumor borders revealed by NIF of surgical resection specimens, which was positively correlated with pathological tumor border (r=0.809, P<0.001). Conclusions: ICG NIF technique can effectively detect the residual cancer cells at the incision margin, which is of great clinical value in reducing local recurrence of OSCC after surgery due to intraoperative cancer residue.
目的： 探讨吲哚菁绿(ICG)近红外荧光(NIF)成像技术在口腔鳞状细胞癌(OSCC)术中实时监测切缘癌残留的可行性。 方法： 对2019年1月至2020年6月在南京大学医学院附属口腔医院口腔颌面外科行手术治疗的35例OSCC患者，术前(12±1) h经肘静脉静脉注射ICG(0.75 mg/kg)，术中对术野和手术切除标本切缘进行NIF成像，并对OSCC组织和口腔正常黏膜进行荧光强度测定，对异常荧光信号处取材并进行快速冰冻病理检查。NIF成像肿瘤边界分级与病理肿瘤边界分级的相关性分析采用Spearman相关分析。 结果： 35例患者的肿瘤病灶均获得清晰的ICG NIF成像，阳性率为100%。OSCC组织的荧光强度为(412.73±146.56)au，高于口腔正常黏膜组织[(279.38±82.56)au，P<0.01]。4例患者术野瘤床和手术切除标本对应的切缘处检测到异常荧光信号，其中2例经病理证实为癌细胞残留，另2例为炎性细胞浸润。OSCC术中应用ICG NIF成像技术的切缘阳性检出率为5.7%(2/35)。35例OSCC患者中，手术切除标本NIF成像显示的肿瘤边界1级20例，2级11例，3级4例，与病理肿瘤边界呈正相关(r＝0.809，P<0.001)。 结论： ICG NIF成像技术可有效检测切缘是否存在癌细胞残留，对降低因术中癌残留导致的OSCC术后局部复发具有重要的临床价值。.
Keywords: Indocyanine green; Mouth neoplasms; Near-infrared fluorescence imaging; Residual cancer; Squamous cell carcinoma.