Narrow-Band Imaging Improves Detection of Colorectal Peritoneal Metastases: A Clinical Study Comparing Advanced Imaging Techniques

• Published in: Annals of surgical oncology 2019-01, Vol.26 (1), p.156-164
• Main Authors: Sluiter, Nina Roelie, Vlek, Stijn Lucas, Wijsmuller, Arthur Randolph, Brandsma, Henk Thijs, de Vet, Henrica Cornelia Wilhelmina, van Grieken, Nicole Cornelia Theodora, Kazemier, Geert, Tuynman, Jurriaan Benjamin
• Format: Article
• Language: English
• Subjects: BIOPSY; CHEMOTHERAPY; Chemotherapy, Cancer, Regional Perfusion; CLINICAL TRIALS; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - pathology; Colorectal Neoplasms - therapy; Coloring Agents; Combined Modality Therapy; Cytoreduction Surgical Procedures; DIAGNOSIS; DISEASES; Female; FLUORESCENCE; Follow-Up Studies; Gastrointestinal Oncology; Humans; Hyperthermia, Induced; Image Processing, Computer-Assisted - methods; INDOCYANINE GREEN; Laparoscopy; Male; Medicine; Medicine & Public Health; METASTASES; Metastasis; Middle Aged; Narrow Band Imaging - methods; NTR; NTR5820; Oncology; PATIENTS; Peritoneal Neoplasms - diagnostic imaging; Peritoneal Neoplasms - secondary; Peritoneal Neoplasms - therapy; PERITONEUM; Prognosis; Prospective Studies; RADIOLOGY AND NUCLEAR MEDICINE; SENSITIVITY; SPECIFICITY; Spectroscopy, Near-Infrared - methods; Surgery; Surgical Oncology; VISIBLE RADIATION
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-018-7005-5

Background Colorectal peritoneal metastases (PM) are often diagnosed in an advanced disease stage. Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) improve survival of patients with colorectal PM, although most benefit is seen in patients with limited peritoneal disease. Advanced imaging techniques might improve the detection of PM, potentially leading to earlier diagnosis and improved cytoreduction. This prospective clinical trial compared three advanced techniques with conventional white-light imaging for the detection of colorectal PM: narrow-band imaging (NBI), near-infrared indocyanine green fluorescent imaging (NIR-ICG), and spray-dye chromoendoscopy (SDCE). Methods Patients with colorectal PM were prospectively included. Prior to cytoreduction and HIPEC, all abdominal regions were inspected with white-light imaging, NBI, NIR-ICG, and SDCE during exploratory laparoscopy. Primary endpoints were sensitivity and specificity for the detection of PM, using pathological examination of biopsied lesions as the reference standard. The safety of all techniques was assessed. Results Between May 2016 and March 2018, four different techniques were analyzed in 28 patients, resulting in 169 biopsies. Sensitivity for the detection of PM significantly increased from 80.0% with white light to 96.0% with NBI ( p  = 0.008), without loss of specificity (74.8% vs. 73.1%, respectively, p  = 0.804). The use of NIR-ICG and SDCE was discontinued after 10 patients had undergone treatment because the lesions were not fluorescent using NIR-ICG, and because SDCE did not visualize the whole peritoneum. No adverse events relating to the imaging techniques occurred. Conclusion NBI substantially increased the detection of PM. This method is safe and could improve the detection of metastatic lesions and help optimize cytoreduction in patients with colorectal PM.