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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2019

Open Access 01-01-2019 | Gastrointestinal Oncology

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

Authors: Nina Roelie Sluiter, MD, Stijn Lucas Vlek, MD, Arthur Randolph Wijsmuller, MD, PhD, Henk Thijs Brandsma, MD, Henrica Cornelia Wilhelmina de Vet, MD, PhD, Nicole Cornelia Theodora van Grieken, MD, PhD, Geert Kazemier, MD, PhD, Jurriaan Benjamin Tuynman, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2019

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Abstract

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.
Appendix
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Metadata
Title
Narrow-Band Imaging Improves Detection of Colorectal Peritoneal Metastases: A Clinical Study Comparing Advanced Imaging Techniques
Authors
Nina Roelie Sluiter, MD
Stijn Lucas Vlek, MD
Arthur Randolph Wijsmuller, MD, PhD
Henk Thijs Brandsma, MD
Henrica Cornelia Wilhelmina de Vet, MD, PhD
Nicole Cornelia Theodora van Grieken, MD, PhD
Geert Kazemier, MD, PhD
Jurriaan Benjamin Tuynman, MD, PhD
Publication date
01-01-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-7005-5

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