Clinical Application of Fluorescence Imaging of Liver Cancer Using Indocyanine Green

Abstract

Recently, fluorescence imaging using indocyanine green (ICG) has been applied to hepatobiliary surgery, not only to visualize the bile ducts, but also to identify liver cancer during surgery. In this technique, ICG is administered intravenously at a dose of 0.5 mg/kg body weight for routine liver function testing before surgery. Intraoperatively, liver cancer can be readily identified by fluorescence imaging on the liver surface before resection and on the cut surface of the resected specimen. This is achieved by visualizing fluorescence from the area of impaired bile excretion in hepatocellular cancer tissue and in the liver parenchyma surrounding metastatic liver cancers. Liver cancer navigation surgery, first developed in Japan, is also possible, and it represents one of the few fluorescence imaging techniques for cancer that have reached the stage of clinical application; with further developments in basic research, fluorescence imaging is expected to become an indispensable technique for the diagnosis and treatment of liver cancer.

Different ways to manage indocyanine green fluorescence to different purposes in liver surgery: A systematic review

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] A total of 718 cases were globally analyzed as study group. No side effects of ICG were reported in any articles.…”

“…7,29 On the other side, many advantages are described in detection of small nodules unknown before surgery with a statistical significant difference compared to intra-operative ultrasound. 9,13,19,21 Ishizawa et al 9 showed in their report that 13% of lesions were not evident unless observed by ICG fluorescent imaging. Gotoh et al 13 found 40% of new HCC nodules that were not detected by any preoperative and intraoperative examination, including IOUS.…”

Clinical application of indocyanine green (ICG) fluorescent imaging of hepatoblastoma

“…It allows visualization of the areas of impaired bile excretion in or around the tumor tissues. In addition, well-differentiated HCC tissue exhibits intense fluorescence on the cut surface of surgically-resected liver specimens, whereas for poorly differentiated HCC and metastasis of colorectal cancer, the cancer tissue itself is not visualized [7]. Therefore, it has been suggested that well differentiated HCC tissues take up ICG, but the biliary excretion of ICG is impaired because of morphological or functional abnormalities.…”

Interventional Optical Molecular Imaging Guidance during Percutaneous Biopsy

“…Ill (2)(3)(4)(5)(6). The intraoperative imaging of ICG for the detection of intrahepatic malignancy has been demonstrated (2,3,6).…”