A comparison of indocyanine green fluorescence and laparoscopic ultrasound for detection of liver tumors

Abstract

Background: Indocyanine green (ICG) fluorescence imaging (ICG-FI) has been suggested for intraoperative identification of liver tumors. We aim to compare the intraoperative diagnostic utility of this imaging modality with laparoscopic ultrasound (LUS).Methods: This is an IRB-approved prospective study. ICG was administered intravenously 1-2 days before surgery. The findings on ICG-FI were compared to those on preoperative cross-sectional imaging (POCSI), LUS, diagnostic laparoscopy (DL). Results: A total of 144 lesions (62 superficial [visible on DL] and 82 deep) were detected in the study patients. POCSI identified 74%, LUS identified 92%, and ICG-FI identified 43%. ICG-FI detection rate was higher for superficial (95%) versus deep lesions (4%). 3% (4/144) of all lesions were seen only on ICG-FI. However, all of these lesions were small and superficial lesions that were apparent on DL. Conclusion:Although ICG-FI allowed detection of small superficial lesions that were not identifiable by POCSI or LUS, these lesions were apparent on DL even before ICG-FI. Therefore, its utility as an intraoperative diagnostic modality is limited at the dosage and timing used in the study. We believe that rather than a diagnostic tool, it has more potential for a dynamic use in guiding the resection of superficial lesions and delineating segmental/lobar anatomy.

Role of Indocyanine Green Fluorescence Imaging in Minimally Invasive Resection of Colorectal Liver Metastases

“…The final review included 13 articles, that is, 6 prospective cohort studies, 1 retrospective cohort study, 3 case series, 1 case report, 1 case-matched study, and 1 clinical trial registry (Table 1). 14,15,[18][19][20][21][22][23][24][25][26][27][28]…”

“…Some authors prefer a tailored dose of 0.3 to 0.5 mg/kg,15,18–21,25,28 while others administer a standardized dose of 10 mg 14,22,28…”

“…The choice of ICG dosage is also dependent on the timing of ICG injection, which ranges widely (ie, between 1 and 14 d before surgery) 14,18–21,25,26,28,31–33…”

“…Boogerd et al Takahashi et al 20 5 patients = 7.5 mg 1 patient = 5 mg 5 patients: 1 d before surgery 1 patient: intraoperatively Terasawa et al 21 0.5 mg/kg Within 3 d before surgery Boogerd et al 14 10 mg 1 d before surgery Handgraaf et al 22 10 mg/20 mg 1-2 d before surgery Marino et al 23 2.5 mg Intraoperatively Marino et al 24 2.5 mg Intraoperatively Kose et al 25 0.5 mg/kg 4-7 d before surgery Achterberg et al 26 averages of 77.42%, 95.97%, 79.03%, and 100%, respectively (Table 3). In other studies, 14,19,21 ICG allowed the detection of occult CRLMs (tumor size ranging from 1 to 5 mm) which were not diagnosed with other preoperative or intraoperative techniques.…”

Laparoscopic liver resection: indications, limitations, and economic aspects

“…3D laparoscopy, as is standard practice at the Hôpital Pitié-Salpêtrière in Paris, should be mentioned as an another example for important supportive visual techniques. Use of indocyanine green (ICG), being widely used in Japan and experienced centers elsewhere, can further help to both detect superficial lesions and guide difficult parenchymal dissection [51]. Research is being conducted on the application of virtual realities, what could also be beneficial in this context [52,53].…”