Expert consensus on indocyanine green fluorescence imaging for thoracoscopic lung resection (The Version 2022)

Abstract

The use of the white-light thoracoscopy is hampered by the low contrast between oncologic margins and surrounding normal parenchyma. As a result, many patients with in situ or micro-infiltrating adenocarcinoma have to undergo lobectomy due to a lack of tactile and visual feedback in the resection of solitary pulmonary nodules. Near-infrared (NIR) guided indocyanine green (ICG) fluorescence imaging technique has been widely investigated due to its unique capability in addressing the current challenges; however, there is no special consensus on the evidence and recommendations for its preoperative and intraoperative applications. This manuscript will describe the development process of a consensus on ICG fluorescence-guided thoracoscopic resection of pulmonary lesions and make recommendations that can be applied in a greater number of centers. Specifically, an expert panel of thoracic surgeons and radiographers was formed. Based on the quality of evidence and strength of recommendations, the consensus was developed in conjunction with the Chinese Guidelines on Video-assisted Thoracoscopy, and the National Comprehensive Cancer Network (NCCN) guidelines on the management of pulmonary lesions. Each of the statements was discussed and agreed upon with a unanimous consensus amongst the panel. A total of 6 consensus statements were developed. Fluorescence-guided thoracoscopy has unique advantages in the visualization of pulmonary nodules, and recognition and resection of the anterior plane of the pulmonary segment. The expert panel agrees that fluorescence-guided thoracoscopic surgery has the potential to become a routine operation for the treatment of pulmonary lesions.

Impact of near-infrared fluorescence imaging with indocyanine green on the surgical treatment of pulmonary masses in dogs

“…Furthermore, the percentage of false positives (cases in which fluorescence was observed at the resection margin despite being a complete resection) was high. In humans, a previous study reported that ICG is metabolized in the liver, resulting in shorter visualization times in the lungs (26). Moreover, it has been reported that ICG can be administered intravenously at 1-5 mg/kg for the fluorescence imaging of human pulmonary tumors (27)(28)(29) maximum dose of ICG for intravenous injection in humans is set at 5.0 mg/kg (30)(31)(32)(33)(34).…”

Near-Infrared Fluorescence Imaging with Intravenous Indocyanine Green Method in Segmentectomy for Infants with Congenital Pulmonary Airway Malformation

“…According to the FDA guidelines, the usual ICG doses for children and infants are 2.5 and 1.25 mg, respectively. 13 Expert consensus on ICG-guided NIRF for thoracoscopic lung resection from Fei et al recommends the use of an ICG diluent, 14 and the reported dose for thoracoscopic lung surgery in children is 0.25 mg/mL/kg. 15 Based on the above, our center administers a dose of 0.25 mg/kg for infants weighing less than 5 kg and 1.25 mg/body for those weighing more than 5 kg (25 mg dissolved in 100 mL saline, equivalent to 0.25 mg/mL).…”

Editorial: Near-infrared fluorescence guided surgery: State of the evidence from a health technology assessment perspective

“…In contrast, given the low-quality evidence for the detection of sentinel lymph nodes, additional research is required to evaluate its role in this context. In addition, the panel of experts felt that fluorescence-guided thoracoscopic surgery could become a standard procedure for treating pulmonary lesions (8). 4.…”