Intraoperative fluorescence imaging with indocyanine green in hepatic resection for malignancy: a systematic review and meta-analysis of diagnostic test accuracy studies

Purich, Kieran; Dang, Jerry; Poonja, Ali; Sun, Warren; Bigam, David L.; Birch, Daniel W.; Karmali, Shahzeer

doi:10.1007/s00464-020-07543-2

Cited by 38 publications

(21 citation statements)

References 47 publications

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“…The other two nodules were subcentimetric and neither was seen on the preoperative CT scan or with intraoperative standard of care. The utility of ICG hepatic tumor localization has been confirmed by previous studies ( 28 , 29 ), which is in keeping with our findings that liver primary and metastatic deposits were consistently fluorescent ( Figure 3 ). Also, ICG guidance helped identify a medial tumor extension of myoepithelial carcinoma of the chest wall otherwise not differentiated from adjacent normal muscle.…”

Section: Discussionsupporting

confidence: 92%

Indocyanine Green–Guided Pediatric Tumor Resection: Approach, Utility, and Challenges

et al. 2021

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Incomplete tumor resection increases the risk of local recurrence. However, the standard of care approach to distinguishing tumor tissue is less than optimal, as it depends on a conglomeration of preoperative imaging and visual and tactile indicators in real time. This approach is associated with a significant risk of inadequate resection; therefore, a novel approach that delineates the accurate intraoperative definition of pediatric tumors is urgently needed. To date, there is no reliable method for the intraoperative assessment of tumor extent and real-time differentiation between tumor- involved tissues and tumor-free tissues. Use of intraoperative frozen sections is challenging, time consuming, and covers a small surface area. Increased vascular permeability and impaired lymphatic drainage in the tumor microenvironment leads to an enhanced permeability and retention effect of small molecules. ICG is a fluorescent dye that when administered intravenously accumulates passively in the tumor because of EPR, thereby providing some tumor contrast for intraoperative real-time tumor recognition. Preclinical and clinical studies suggest that the tumor-to-background fluorescence ratio is optimized when imaging is obtained 24 h after dye injection, and many studies suggest using a high dose of ICG to optimize dye retention in the tumor tissue. However, in childhood cancers, little is known about the ideal dosing, applications, and challenges of ICG-guided tumor resection. This retrospective study examines the feasibility of ICG-guided tumor resection in common childhood solid tumors such as neuroblastoma, sarcomas, hepatic tumors, pulmonary metastases, and other rare tumors. Pediatric dosing and challenges related to the optimization of tumor-to-background ratio are also examined.

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Section: Discussionsupporting

confidence: 92%

Indocyanine Green–Guided Pediatric Tumor Resection: Approach, Utility, and Challenges

et al. 2021

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“…After intravenous administration, ICG is ingested by hepatocytes and expelled out almost entirely through the biliary system within a few hours. It was widely reported that ICG would be retained at the lesion site of liver tumor and can exhibit continuous green fluorescence under the near-infrared light detector [10]. The underlying mechanism may be that after tumor occurrence, the portal vein remains a normal function of ICG uptake, but the biliary tract has impaired functions in the excretion of ICG.…”

Section: Discussionmentioning

confidence: 99%

“…NIRF imaging for surgical treatment has been widely reported, especially its application to the liver and biliary tract surgeries ( 10 , 11 ). The use of this technique involves a solution named ICG.…”

Section: Discussionmentioning

confidence: 99%

Attempt of Real-Time Near-Infrared Fluorescence Imaging Using Indocyanine Green (ICG) in Radical Resection of Gallbladder Cancer: A Case Report

et al. 2021

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Surgery is the mainstay of treatment for resectable gallbladder cancer. Near-infrared fluorescence (NIRF) imaging using ICG is an innovation in laparoscopic surgery, which can provide real-time navigation during the whole operation. In this article, we present a 56-year older woman with gallbladder cancer, in which we evaluated the applicability of NIRF imaging using ICG for tumor and biliary tree visualization during the operative procedure of gallbladder cancer. The tumor and biliary tree were clearly visualized by utilizing a green fluorescence dye. The patient was successfully operated radical resection of gallbladder cancer under fluorescence laparoscope, without any complications. According to this case, the utilization of ICG based NIRF imaging is feasible and beneficial in identifying tumors and the biliary tree during radical resection. It can assist in the achievement of a negative margin and lymphatic clearance around the biliary tree. However, further studies are needed to corroborate the results of this case.

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“…Since the first clinical trial of FLI with tumourspecific NIR fluorescent agents [45], ground-breaking results have been reported in patients with various cancer types, consistently showing excellent safety records [43][44][45][46][47][48][49][50][51][52][53][54]74]. Indocyanine green (ICG), a nonspecific and US Food and Drug Administration approved compound, has commonly been used for FLI in various settings [75,76]. Methylene blue (MB) was approved as the second NIR fluorescent agent for fluorescence-based intraoperative imaging [77].…”

Section: Image-guided Cancer Surgery Using Fluorescence Imagingmentioning

confidence: 99%

The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles

Lauwerends

Abbasi

Schut

et al. 2022

Eur J Nucl Med Mol Imaging

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A clear margin is an important prognostic factor for most solid tumours treated by surgery. Intraoperative fluorescence imaging using exogenous tumour-specific fluorescent agents has shown particular benefit in improving complete resection of tumour tissue. However, signal processing for fluorescence imaging is complex, and fluorescence signal intensity does not always perfectly correlate with tumour location. Raman spectroscopy has the capacity to accurately differentiate between malignant and healthy tissue based on their molecular composition. In Raman spectroscopy, specificity is uniquely high, but signal intensity is weak and Raman measurements are mainly performed in a point-wise manner on microscopic tissue volumes, making whole-field assessment temporally unfeasible. In this review, we describe the state-of-the-art of both optical techniques, paying special attention to the combined intraoperative application of fluorescence imaging and Raman spectroscopy in current clinical research. We demonstrate how these techniques are complementary and address the technical challenges that have traditionally led them to be considered mutually exclusive for clinical implementation. Finally, we present a novel strategy that exploits the optimal characteristics of both modalities to facilitate resection with clear surgical margins.

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Intraoperative fluorescence imaging with indocyanine green in hepatic resection for malignancy: a systematic review and meta-analysis of diagnostic test accuracy studies

Cited by 38 publications

References 47 publications

Indocyanine Green–Guided Pediatric Tumor Resection: Approach, Utility, and Challenges

Indocyanine Green–Guided Pediatric Tumor Resection: Approach, Utility, and Challenges

Attempt of Real-Time Near-Infrared Fluorescence Imaging Using Indocyanine Green (ICG) in Radical Resection of Gallbladder Cancer: A Case Report

The complementary value of intraoperative fluorescence imaging and Raman spectroscopy for cancer surgery: combining the incompatibles

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