A clinical trial of intraoperative near‐infrared imaging to assess tumor extent and identify residual disease during anterior mediastinal tumor resection

Predina, Jarrod D.; Keating, Jane; Newton, Andrew D.; Corbett, Christopher; Xia, Leilei; Shin, Michael; Sulyok, Lydia Frenzel; Deshpande, Charuhas; Litzky, Leslie A.; Nie, Shuming; Kucharczuk, John C.; Singhal, Sunil

doi:10.1002/cncr.31851

Cited by 27 publications

(31 citation statements)

References 20 publications

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“…In oncologic surgery, it is used for sentinel lymph node mapping and intraoperative identification of tumors [44]. Due to intratumoral injection, exact tumor margins can be visualized, ensuring safe resection without damage of surrounding tissue [45,46]. Moreover, it can be injected into the epineurium of nerves to improve the intraoperative visualization and to avoid accidental damage [47].…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green for Leakage Control in Isolated Limb Perfusion

Zucal

Geis

Prantl

et al. 2021

JPM

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Sarcomas are characterized by a high metastatic potential and aggressive growth. Despite surgery, chemotherapy plays an important role in the treatment of these tumors. Optimal anti-cancer therapy with maximized local efficacy and minimized systemic side effects has been the object of many studies for a long time. To improve the local efficacy of anti-tumor therapy, isolated limb perfusion with high-dose cytostatic agents has been introduced in surgical oncology. In order to control the local distribution of substances, radiolabeled cytostatic drugs or perfusion solutions have been applied but often require the presence of specialized personnel and result in a certain exposure to radiation. In this study, we present a novel strategy using indocyanine green to track tumor perfusion with high-dose cytostatic therapy. In a rat cadaver model, the femoral vessels were cannulated and connected to a peristaltic pump to provide circulation within the selected limb. The perfusion solution contained indocyanine green and high-dose doxorubicin. An infrared camera enabled the visualization of indocyanine green during limb perfusion, and subsequent leakage control was successfully performed. Histologic analysis of sections derived proximally from the injection site excluded systemic drug dispersion. In this study, the application of indocyanine green was proven to be a safe and cost- and time-efficient method for precise leakage control in isolated limb perfusion with a high-dose cytostatic agent.

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Section: Discussionmentioning

confidence: 99%

Indocyanine Green for Leakage Control in Isolated Limb Perfusion

Zucal

Geis

Prantl

et al. 2021

JPM

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“…With regard to conditions in the esophagus, ICG is used to prevent the complication of chylothorax during esophagectomy, which is performed to identify the thoracic duct (9). In the mediastinum, although identification of mediastinal tumors or lymph node metastases is attempted, these techniques remain in the basic experimental stage and have not yet been used in daily practice (10,11). While a large uptake of ICG was reported in pulmonary metastases such as hepatoblastoma ( 12), ICG uptake is generally recognized to be nonuniform in pulmonary metastases from other organs (13).…”

Section: Discussionmentioning

confidence: 99%

Fluorescence-guided thoracic surgery

Nakamura¹,

Goto²,

Chen‐Yoshikawa³

2021

J Vis Surg

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Recently, the use of sublobar resection has become increasingly common for patients that were previously planned to undergo lobectomy. We encountered two challenges when performing sublobar resections for patients with small pulmonary nodules; one challenge was obtaining a sufficient surgical margin and the other was identifying the location of the nodules, especially in minimally invasive surgery. In recent years, indocyanine green (ICG) fluorescence has been used to solve these two problems in thoracic surgery: first, identifying the accurate intersegmental plane in anatomical lung segmentectomy for detecting the regions of residual pulmonary blood flow, and second, displaying the tumor location or optimal resection line intraoperatively as ICG virtual-assisted lung mapping (ICG-VAL-MAP). The purpose of this article is to present a review of the outcomes of fluorescence-guided thoracic surgery, and also our techniques in minimally invasive surgery using ICG fluorescence. We showed that patients received anatomical pulmonary resection that identified the intersegmental or interlobar plane using ICG guidance in video-assisted thoracic surgery (VATS) or in robot-assisted segmentectomy. We also showed that patients received pulmonary wedge resection, displaying the tumor location intraoperatively using ICG. Furthermore, we introduced a technique of preoperative transbronchial lung marking for small lung nodules called ICG-VAL-MAP.Fluorescence guidance in minimally invasive thoracic surgery makes it possible to ensure a safe surgical margin and identify the intersegmental line and location of the nodules accurately.

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“…In 2006, Stankoff et al and Wu et al, respectively, reported 1,4-bis(p-aminostyryl)-2-methoxy benzene (BMB) 104 and (E,E)-1,4-bis(49-aminostyryl)-2-dimethoxy benzene (BDB) 105 that can selectively stain white matter in animals and human by binding to myelin. Since then, a series of distyrylbenzene derivatives have been developed to highlight myelinated nerves, including GE 3082, 106 GE3111, 107 and GE3126.…”

Section: Nerve Imaging By Fluorescence Probesmentioning

confidence: 99%

“…For instance, He et al successfully employed ICG to perform real‐time imaging of thoracic sympathetic nerves in patients with pulmonary nodules 102 . ICG was also utilized to access phrenic nerve involvement and identify nodules in anterior mediastinal tumor resection 103 . Although such fluorescent dyes are trapped in blood vessels, they not only visualize tumors that are normally undetectable by human vision, but can also indicate the peripheral nerves due to the presence of vasa nervorum.…”

Section: Preservation Of Healthy Tissue: Imaging Of Vital Structuresmentioning

confidence: 99%

Exploiting molecular probes to perform near‐infrared fluorescence‐guided surgery

Zhang

2020

VIEW

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Near-infrared (NIR) fluorescence imaging can provide real-time navigation for surgeons to discriminate boundaries between lesions and healthy tissue, which serves as a promising tool to enhance precise diagnosis and accurate excision during surgery. Molecular probes with NIR fluorescence can visualize diseased tissue in deep penetration with improved signal-to-noise ratio, which considerably encourages the active participation of NIR fluorescence-guided surgery in the operating room. Although a great quantity of fluorescent probes has been employed in clinical trials, the U.S. Food and Drug Administration only approves an extremely narrow number of contrast agents for clinical use so far. Currently, there remain two significant problems to be addressed in surgical resection: accurate identification of diseased tissue and the preservation of adjacent vital structures. Here, molecular probes with NIR fluorescence are systematically reviewed to offer possible solutions to these two problems. Targeting strategies of fluorescent probes are introduced, where the strengths and weaknesses of each strategy are presented. Advances in fluorescent probes for the imaging of vital structures, such as nerve and ureter, are also summarized in this review. It is convinced that NIR fluorescence-guided surgery has the potential to improve current surgical resection and ameliorate the postoperative outcomes of diverse diseases.

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A clinical trial of intraoperative near‐infrared imaging to assess tumor extent and identify residual disease during anterior mediastinal tumor resection

Cited by 27 publications

References 20 publications

Indocyanine Green for Leakage Control in Isolated Limb Perfusion

Indocyanine Green for Leakage Control in Isolated Limb Perfusion

Fluorescence-guided thoracic surgery

Exploiting molecular probes to perform near‐infrared fluorescence‐guided surgery

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