The recurrence rate of soft tissue and bone sarcomas strongly correlates to the status of the surgical margin after excision, yet excessive removal of tissue may lead to distinct, otherwise avoidable morbidity. Therefore, adequate margination of sarcomas both pre- and intra-operatively is a clinical necessity that has not yet fully been met. Current guidance for soft-tissue sarcomas recommends an ultrasound scan followed by magnetic resonance imaging (MRI). For bone sarcomas, two plane radiographs are required, followed similarly by an MRI scan. The introduction of more precise imaging modalities may reduce the morbidity associated with sarcoma surgery; the PET-CT and PET-MRI approaches in particular demonstrating high clinical efficacy. Despite advancements in the accuracy in pre-operative imaging, translation of an image to surgical margins is difficult, regularly resulting in wider resection margins than required. For soft tissue sarcomas there is currently no standard technique for image guided resections, while for bone sarcomas fluoroscopy may be used, however margins are not easily discernible during the surgical procedure. Near infra-red (NIR) fluorescence guided surgery offers an intra-operative modality through which complete tumour resection with adequate tumour-free margins may be achieved, while simultaneously minimising surgical morbidity. NIR imaging presents a potentially valuable adjunct to sarcoma surgery. Early reports indicate that it may be able to provide the surgeon with helpful information on anatomy, perfusion, lymphatic drainage, tumour margins and metastases. The use of NIR fluorochromes have also been demonstrated to be well tolerated by patients. However, prior to widespread implementation, studies related to cost-effectiveness and the development of protocols are essential. Nevertheless, NIR imaging may become ubiquitous in the future, carrying the potential to transform the surgical management of sarcoma.

中文翻译：

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肉瘤手术的图像增强技术的进展。

切除后软组织和骨肉瘤的复发率与手术切缘的状态密切相关，但过多切除组织可能导致明显的，可避免的发病率。因此，术前和术中肉瘤的充分切缘是尚未完全满足的临床需要。当前关于软组织肉瘤的指南建议超声扫描，然后进行磁共振成像（MRI）。对于骨肉瘤，需要两张X光片，然后类似地进行MRI扫描。引入更精确的成像方式可以减少与肉瘤手术相关的发病率。PET-CT和PET-MRI方法尤其具有很高的临床疗效。尽管术前成像的准确性有所提高，很难将图像转换为手术切缘，通常会导致切除切缘比要求的要宽。对于软组织肉瘤，目前尚无用于图像引导切除的标准技术，而对于骨肉瘤，可以使用透视检查法，但是在手术过程中切缘不易辨认。近红外（NIR）荧光引导手术提供了一种术中方式，通过该方式可以实现具有足够的无肿瘤切缘的完整肿瘤切除，同时将手术发病率降至最低。NIR成像是肉瘤手术的潜在有价值的辅助手段。早期报道表明，它可能能够为外科医生提供有关解剖结构，灌注，淋巴引流，肿瘤切缘和转移的有用信息。NIR荧光染料的使用也已被患者很好地耐受。但是，在广泛实施之前，与成本效益和协议制定相关的研究至关重要。尽管如此，NIR成像在未来可能会变得无处不在，具有改变肉瘤手术治疗的潜力。