New Intraoperative Imaging Tools and Image-Guided Surgery in Gastric Cancer Surgery

Abstract

Innovations and new advancements in intraoperative real-time imaging have gained significant importance in the field of gastric cancer surgery in the recent past. Currently, the most promising procedures include indocyanine green fluorescence imaging (ICG-FI) and hyperspectral imaging or multispectral imaging (HSI, MSI). ICG-FI is utilized in a broad range of clinical applications, e.g., assessment of perfusion or lymphatic drainage, and additional implementations are currently investigated. HSI is still in the experimental phase and its value and clinical relevance require further evaluation, but initial studies have shown a successful application in perfusion assessment, and prospects concerning non-invasive tissue and tumor classification are promising. The application of machine learning and artificial intelligence technologies might enable an automatic evaluation of the acquired image data in the future. Both methods facilitate the accurate visualization of tissue characteristics that are initially indistinguishable for the human eye. By aiding surgeons in optimizing the surgical procedure, image-guided surgery can contribute to the oncologic safety and reduction of complications in gastric cancer surgery and recent advances hold promise for the application of HSI in intraoperative tissue diagnostics.

The Use of Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence-Guided Imaging in Gastric Cancer Surgery: A Narrative Review

“…A fascinating angle on new technologies that could well integrate with ICG fluorescence imaging is offered by studies on hyperspectral imaging (HSI) and confocal laser endomicroscopy (CLE). HSI is a method able, through real time analysis of tissues’ chemical properties, to potentially detect early mucosal lesions, to measure anastomotic perfusion, to assess resection margins and extent of node dissection in combination with deep learning models ( 80 ). CLE is, on the other hand, an optical imaging modality that provides an in vivo histopathological assessment of the mucosa, for example in terms of quality of perfusion.…”

Validation of a surgical training model containing indocyanine green for near‐infrared fluorescence imaging

“…ICG is by far the most widely used tissue perfusion agent within fluorescence‐guided surgery due to its absorption and emission in the NIR range, low toxicity, and history of use within medicine for over half a century 19 . Currently, fluorescence‐guided surgery with ICG is utilized in a broad range of clinical applications, such as assessment of blood perfusion or lymphatic drainage, and can contribute to the oncologic safety and reduction of complications 20 . 5‐ALA is a nonfluorescent prodrug that leads to intracellular accumulation of fluorescent porphyrins and enables more complete resections of contrast‐enhancing tumors in patients with malignant glioma 21 .…”

“… 19 Currently, fluorescence‐guided surgery with ICG is utilized in a broad range of clinical applications, such as assessment of blood perfusion or lymphatic drainage, and can contribute to the oncologic safety and reduction of complications. 20 5‐ALA is a nonfluorescent prodrug that leads to intracellular accumulation of fluorescent porphyrins and enables more complete resections of contrast‐enhancing tumors in patients with malignant glioma. 21 Furthermore, in a recent study, 5‐ALA has been used for transurethral tumor resection and cystoscopy in patients with bladder cancer.…”

A hyperspectral dataset of precancerous lesions in gastric cancer and benchmarks for pathological diagnosis

“…Recently, many studies have been devoted to improving the accuracy of CAD with HSI. Knospe et al [25] used hyperspectral imaging to assess the effect of perfusion during gastrectomy in real time. Hyperspectral imaging accurately visualizes tissue features, which are indistinguishable to human eye.…”