Advances and Challenges of Near-infrared Fluorescence Imaging in the Diagnosis and Treatment of Bladder Cancer
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摘要: 膀胱癌（bladder cancer，BCa）是常见的泌尿系统恶性肿瘤，早期精准诊疗对改善患者预后至关重要。近红外荧光成像（near-infrared fluorescence imaging，NIRFI）因其低背景干扰、高信噪比及实时成像能力，在膀胱癌的诊断与治疗中展现出重要应用潜力。本文综述近红外荧光成像技术在膀胱癌中的研究进展，重点总结靶向荧光探针的设计策略及其在肿瘤识别、边界判定和淋巴结定位中的应用，并归纳其在经尿道手术及相关操作中的辅助价值。在此基础上，进一步分析该技术在组织穿透深度、信号定量一致性及临床标准化方面的主要挑战，并探讨其与光热/光动力治疗、多模态成像及人工智能融合的发展趋势，旨在为近红外荧光成像在膀胱癌中的进一步研究与临床转化提供参考。Abstract: Bladder cancer （BCa） is a common malignancy of the urinary system, and early precise diagnosis and treatment are essential for improving prognosis. Near-infrared fluorescence imaging （NIR）, with low background interference, high signal-to-noise ratio, and real-time imaging capability, has shown promising potential in bladder cancer management. This review summarizes recent advances in NIR imaging for bladder cancer, focusing on the design of targeted fluorescent probes and their applications in tumor detection, margin delineation, and lymph node localization, as well as their value in transurethral surgery and related procedures. Current challenges, including limited tissue penetration, inconsistency in signal quantification, and insufficient clinical standardization, are also discussed. In addition, future directions involving photothermal/photodynamic therapy, multimodal imaging, and artificial intelligence are highlighted. This review may provide a reference for further research and clinical translation of NIR imaging in bladder cancer.
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图 1 近红外荧光成像在膀胱癌诊疗中的应用流程图
Figure 1. Workflow of near-infrared fluorescence imaging in bladder cancer diagnosis and treatment
表 1 近红外荧光成像与其他常用成像技术在膀胱癌诊疗中的比较
Table 1. Comparison of near-infrared fluorescence imaging with other commonly used imaging techniques in the diagnosis and treatment of bladder cancer
技术 主要优势 主要局限 成本/便捷性 主要适用场景 白光膀胱镜 临床普及度高，操作成熟 对平坦病灶、CIS和微小病灶识别不足 成本较低，便捷性高 常规筛查、随访 超声成像 无创、动态、床旁可用 对微小/平坦病灶敏感性有限，分子特异性差 成本较低，便捷性高 初步评估、形态学观察 多参数MRI 软组织分辨率高，适合
肌层浸润与局部分期评估费用较高，术中实时性
不足成本较高，流程较复杂 术前分期、治疗反应评估 近红外荧光成像 实时成像、分子靶向、
适于术中边界识别与导航穿透深度有限，定量标准化不足 设备和探针依赖较大，但术中操作性强 术中导航、淋巴结示踪、成像引导局部治疗 
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表 2 膀胱癌不同近红外靶向探针对比
Table 2. Comparison of different near-infrared targeted probes for bladder cancer
探针类型 代表靶点/机制 主要优势 主要局限 主要适用场景 代表文献 受体靶向型 CD47、CD44v6、EGFR 特异性较强，适于高表达病灶识别 受体表达异质性
影响较大局灶病灶识别、
术后标本验证[6][9][17] 核/细胞内靶向型 c（RGDfK）-AO 细胞内定位更精细 临床转化证据仍有限 实验研究、机制验证 [18] 胶原靶向微环境型 胶原黏附/溶胶-
凝胶转变边界显示较稳定，受异质性影响较小 可能受间质改变影响 NMIBC、边界勾勒 [10] pH响应型 pHLIP-ICG、酸触发“switch-on” 背景低，适合癌前/微小病灶提示 受局部酸度波动影响 表浅病灶、
隐匿病灶识别[19][20][21]
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