Intraoperative enhanced imaging for detection of endometriosis: A systematic review of the literature

Hsien, Shugi; Schols, Rutger M.; Hanegem, Nehalennia van; Bouvy, Nicole D.; Dunselman, G.A.J.; Stassen, Laurents P. S.

doi:10.1016/j.ejogrb.2018.03.020

Cited by 18 publications

(8 citation statements)

References 48 publications

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“…Endometriosis lesions harbor a high degree of neovascularization . Several studies show a better detection rate for peritoneal endometriosis using various enhanced laparoscopic imaging techniques such as 5‐aminolevulinic acid‐induced fluorescence, auto‐fluorescence imaging, methylene‐blue and narrow‐band imaging . Of these techniques, 5‐aminolevulinic acid has been evaluated most extensively; it improved the detection rate, especially of red and white peritoneal lesions, with a sensitivity of up to 100% and a specificity of up to 78%.…”

Section: Introductionmentioning

confidence: 99%

“…Of these techniques, 5‐aminolevulinic acid has been evaluated most extensively; it improved the detection rate, especially of red and white peritoneal lesions, with a sensitivity of up to 100% and a specificity of up to 78%. However, it may have side effects such as photosensitivity, and it has to be administered 1.5‐24 hours prior to surgery; this requirement makes the procedure more complicated …”

Section: Introductionmentioning

confidence: 99%

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Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Siegenthaler

Knabben

Mohr

et al. 2020

Acta Obstet Gynecol Scand

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Introduction:Endometriosis is a common health problem, affecting 10% of women of reproductive age. Laparoscopic surgery is proven to relieve pain and to improve fertility in women with endometriosis. However, identifying peritoneal endometriosis lesions may be difficult due to their polymorphic aspects. Endometriosis lesions harbor a high degree of neovascularization. The visualization of tissue perfusion by the additional use of near infrared fluorescence imaging with indocyanine green (ICG) may improve the detection of endometriosis lesions. Material and methods:In a single-center, prospective, single-arm pilot study, patients undergoing laparoscopic surgery for suspected endometriosis and/or infertility were recruited. All patients first had white light imaging with systematical documentation of all suspicious areas. ICG was then administered intravenously at .3 mg/kg bodyweight and the near infrared imaging was activated and an identical documentation of suspected lesions was performed again. After removal, the specimen were sent to pathology. Clinical trial registration: clinicaltrials.gov NCT03850158. Results:In total, 173 suspected lesions were identified and excised, of which 150 had histologically proven endometriosis. Of the total number, 166 suspected lesions were detected using white-light and 32 with ICG. Among the 32 suspected lesions found with ICG, 22 were confirmed to be endometriosis. Seven additional lesions were identified with ICG alone, of which only one was histologically proven endometriosis. Positive predictive values were 89.8%, 68.8% and 86.7% for white-light laparoscopy alone, near-infrared (NIR)-ICG visualization alone, and the combination of white-light and NIR-ICG, respectively. ICG exposure time, previous abdominal surgery and rARSM stage showed a statistically significant impact on the ICG detection rate. In seven patients, ICG was used for the resection of deep infiltrating nodules from the rectum. In these cases, NIR fluorescence imaging with ICG was useful to define the borders between an endometriotic nodule and healthy tissue. Conclusions: The diagnostic value of NIR-ICG imaging in identifying endometriosis appears to be minimal. ICG exposure time over 20 minutes, no previous abdominal Preoperative symptoms, n (%) Pain 45 (71.4) Infertility 4 (6.3) Both 13 (20.6) Prior surgery for endometriosis, n (%) 34 (54.0) Previous abdominal surgery, n (%) 40 (63.5) Preoperative hormonal treatment, n (%) 38 (60.3) Abbreviations: n, number of patients; SD, standard deviation; rASRM, revised American Society for Reproductive Medicine.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Siegenthaler

Knabben

Mohr

et al. 2020

Acta Obstet Gynecol Scand

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“…1,2 Minimally invasive surgery is the preferred surgical approach because it is usually associated with less pain, shorter hospital stays and faster recovery, in addition to providing better cosmetic outcomes. [3][4][5][6] Although endoscopy allows for magnification of the operative field, the identification of endometriosis implants is not always possible using white light, because some implants may be very small or hidden ("occult lesion"). 7,8 Several authors have emphasized that the persistent growth of endometriotic implants is due to their invasive ability and angiogenic potential.…”

Section: Introductionmentioning

confidence: 99%

Real three‐dimensional approach vs two‐dimensional camera with and without real‐time near‐infrared imaging with indocyanine green for detection of endometriosis: A case‐control study

Vizzielli

Cosentino

Raimondo

et al. 2020

Acta Obstet Gynecol Scand

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Introduction The complete surgical removal of endometriosis lesions is not always feasible because some implants may be very small or hidden. The use of intraoperative near‐infrared radiation (NIR) imaging after intravenous injection of indocyanine green (ICG) coupled with robotic technical advances, including three‐dimensional (3D) and high‐resolution vision, might improve detection rates. Material and methods This is a retrospective, multicenter case‐control study (Canadian Task Force classification II‐2) on medical records of women with endometriosis who underwent surgery at the Catholic University of Rome (Controls) and the University of Bologna (Cases) between January 2016 and March 2018. Surgical and post‐surgical data from the procedures were collected. We compared the visual detection rate of endometriotic lesions using near‐infrared radiation imaging after intravenous injection of indocyanine green (NIR‐ICG) in Real 3D (Cases) with the 2D Camera approach (Controls) in symptomatic women with pelvic endometriosis. Results Twenty cases were matched as closely as possible with 27 controls. The numbers of suspected lesions identified both with the white light and the NIR‐ICG approach were 116 and 70 in the Controls (2D) and Cases (3D), respectively. Among them, 16 of 116 controls (13.8%) and 12 of 70 cases (17.1%) were identified using only NIR‐ICG imaging and collected as occult lesions (P = .536). The overall NIR‐ICG lesion identification showed a positive predictive value of 97.8%, negative predictive value of 82.3%, sensitivity of 82.0%, and specificity of 97.9% for the Control group, and a positive predictive value of 100%, negative predictive value of 97.1%, sensitivity of 97.1%, and specificity of 100% for the Case group, confirming that NIR‐ICG imaging is a good diagnostic and screening test (P = .643 and P = .791, according to the Cohen κ tests, respectively for the laparoscopic and robotic groups). Conclusions The few differences observed did not seem to be clinically relevant, making the 2 procedures comparable in terms of the ability to visually detect endometriotic lesions. Further prospective trials are needed to confirm our results.

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“…Given the typical neovascularization of endometriosis, related to chronic inflammation, the visualization of abnormal areas of peritoneal vascularization could be useful to better identify and define the endometriosis lesions in their real extension and to visualize the lesions even when not obvious, as in puckered peritoneal lesions (8)(9)(10)(11)20). For all of this, several methods have been proposed to improve the intraoperative treatment of endometriosis through enhancing the human vision power, with encouraging results (21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Near-Infrared Imaging With Indocyanine Green for the Treatment of Endometriosis: Results From the Gre-Endo Trial

et al. 2021

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IntroductionA current challenge for endometriosis surgery is to correctly identify the localizations of disease, especially when small or hidden (occult endometriosis), and to exactly define their real extension. The use of near-infrared radiation imaging (NIR) after injection of indocyanine green (ICG) represents one of the most encouraging method. The aim of this study is to assess the diagnostic value of NIR-ICG imaging in the surgical treatment of endometriosis compared with the standard of treatment.Material and MethodsThe Gre-Endo trial is a prospective, single-arm study (NCT03332004). After exploring the operatory field using the white light (WL) mode, patients were injected with ICG and then observed in NIR mode. All suspected areas were classified and chronicled according to lesions visualized only in WL, NIR-ICG, or in the combination of both. Lesion not visualized in WL was considered as suspect occult lesion (s-OcL). In addition, a random control biopsy from an apparent negative peritoneum visualized in WL and NIR-ICG imaging was taken for all patients (control cases). All lesions removed were considered “suspect endometriosis” until pathology.ResultsFifty-one patients were enrolled between January 2016 and October 2019. A total of 240 suspected lesions have been identified with both methods (WL + NIR-ICG). Two hundred and seven (86.2%) lesions out of the overall 240 were visualized with WL imaging, and 200 were confirmed to be pathologic (true positive for WL). The remaining 33/240 (13.75%) (false negative for WL) lesions were identified only with NIR-ICG imaging and collected as s-OcL. All 33 s-OcLs removed were confirmed to be pathologic (c-OcL = 100%). NIR-ICG vision showed PPV of 98.5%, NPV of 87.1%, Se of 87%, and Sp of 98.5%, confirming that this kind of imaging is an excellent diagnostic and screening test (p = 0.001 and p = 0.835, according to McNemar’s and Cohen’s kappa tests, respectively).ConclusionsThe use of NIR-ICG vision alone and combined with WL showed good results in intraoperative detection rate and fluorescence-guided surgery of endometriosis. Furthermore, NIR-ICG allowed surgeons to remove occult lesions that otherwise would remain, leading to possible greater postoperative pain and a higher risk of persistence and relapse.

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Intraoperative enhanced imaging for detection of endometriosis: A systematic review of the literature

Cited by 18 publications

References 48 publications

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Visualization of endometriosis with laparoscopy and near‐infrared optics with indocyanine green

Real three‐dimensional approach vs two‐dimensional camera with and without real‐time near‐infrared imaging with indocyanine green for detection of endometriosis: A case‐control study

Near-Infrared Imaging With Indocyanine Green for the Treatment of Endometriosis: Results From the Gre-Endo Trial

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