Kinetics of indocyanine green: Optimizing tumor to normal tissue fluorescence in image‐guided oral cancer surgery applications

Wang, Yuxin; Xie, Diya; Wang, Ziyang; Zhang, Xudong; Zhang, Qian; Wang, Yang; Newton, Andrew D.; Singhal, Sunil; Cai, Huiming; Wang, Yiqing; Lu, Qian; Hu, Qingang; Wang, Zhiyong

doi:10.1002/hed.25541

Cited by 15 publications

(10 citation statements)

References 36 publications

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“…ICG is a small molecule that has been used in medical imaging for decades. Previous studies have focused on the imaging of soft and vascularized tissues (Fang et al, ; Wang et al, ). To our knowledge, no report of ICG‐guided imaging on necrotic hard tissues is available in literature.…”

Section: Resultsmentioning

confidence: 99%

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The feasibility of locating the affected bone of BRONJ with indocyanine green

et al. 2020

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The morbidity of bisphosphonate‐related osteonecrosis of the jaw (BRONJ) is also increasing with the use of bisphosphonates (BPs). Removing affected bone accurately is the most effective treatment. This study aimed to explore the feasibility of Indocyanine green (ICG)‐based Near‐Infrared fluorescence (NIF) imaging to remove BRONJ affected bone. Firstly, the rat model of BRONJ was constructed. And 5 mg/kg ICG were injected via tail vein, after 12 hr, the affected and healthy bone were dissected for ICG‐based NIF imaging and quantification detection of fluorescence intensity. Finally, all the bone samples were sent for further pathological examination. All the affected bone tissues in rat BRONJ model were fluorescence developed with ICG. And the fluorescence developed regions were further confirmed as affected bone tissues with pathological examination. The fluorescence intensity in affected bone tissues, adjacent, and opposite bone tissues was 1.93*107 ± 2.08*106, 1.19*106 ± 2.33*105, and 1.24*106 ± 1.57*105, respectively (p < .05). Conclusions It was feasible that the extent of affected bone in rat model with BRONJ could be estimated intraoperative via ICG‐based NIF imaging. This novel approach would become an auxiliary method in the treatment of patients with BRONJ in the future.

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Section: Resultsmentioning

confidence: 99%

“…An appropriate removal of the affected bone remains an unresolved issue for clinicians. Indocyanine green (ICG), a molecular probe approved by FDA, has been applied in bio‐imaging for many years (Fang et al, ; Migliorati, Epstein, Abt, & Berenson, ; Wang et al, ). However, imaging of affected bone with ICG has not been reported.…”

Section: Introductionmentioning

confidence: 99%

The feasibility of locating the affected bone of BRONJ with indocyanine green

et al. 2020

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“…Twelve hours before surgery, 0.75 mg/kg of ICG solution (ICG was diluted into 30 mL of distilled water) was injected through the antecubital vein via an intravenous pump for over 30 minutes (26). During surgery, the fluorescence image of lymphatic tissues in the neck region was captured by a NIF imaging-guided instrument after the subplatysmal flap and sternocleidomastoid were raised carefully.…”

Section: Workflow Of Intravenous Injection Of Icgmentioning

confidence: 99%

Comparative study on the diagnostic value of intravenous/ peritumoral injection of indocyanine green for metastatic lymph node location in patients with head and neck squamous cell carcinoma (HNSCC)

Xia¹,

Zhou²,

Zhang³

et al. 2021

Ann Transl Med

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Background: Accurate assessment of regional lymph node (LN) status is essential for the treatment of head and neck squamous cell carcinoma (HNSCC) patients. In this study, we aimed to compare the difference between intravenous injection of indocyanine green (ICG) and peritumoral injection of ICG in the location of metastatic LNs.Methods: Twenty-nine patients were enrolled in this study with 13 patients receiving intravenous injection of ICG and 16 patients receiving peritumoral injection of ICG. During the surgery, the fluorescence-positive LNs in vivo were sent to undergo frozen section after fluorescence intensity was recorded. After the cervical LN dissection, all LNs were sorted by region, and the fluorescence intensity was recorded before the LNs were sent for paraffin section.Results: During the surgery, both intravenous or peritumoral injections with near-infrared (NIR) fluorescence imaging of ICG had their respective pros and cons in vivo, with the sensitivity and specificity being 62.5%/75% and 98.1%/89.1% respectively. After the surgery, both methods could reduce the pathological workload by preselecting the LNs at-risk in the premise of accurate assessing the cervical LN stage. However, intravenous ICG administration was more valuable in determining all types of LN status according to the fluorescence intensity [area under the curve (AUC): 0.91 vs. 0.78, P<0.001].Conclusions: With the assistance of NIR fluorescence imaging using ICG, both administration methods could reduce the postoperative complication and the pathological workload, whereas the intravenous mode of ICG administration is superior in application value.

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“…However, this is impractical for patients with TSCC and for clinicians because of its high cost and time consumption (9). Near-infrared fluorescent imaging using indocyanine green (ICG) can detect the surgical margin during surgery and has been applied in breast, colon, lung, and several cancer types to position the PSM successfully (10)(11)(12)(13)(14). However, for patients with OSCC, secondary inflammation caused by bacteria inhabiting the oral cavity may produce a false PSM due to enhanced permeability and retention effects (15).…”

Section: Introductionmentioning

confidence: 99%

“…However, for patients with OSCC, secondary inflammation caused by bacteria inhabiting the oral cavity may produce a false PSM due to enhanced permeability and retention effects (15). Moreover, the 1-3 mm penetration depth of ICG fluorescence is limited to the evaluated surgical margin on specimens (14).…”

Section: Introductionmentioning

confidence: 99%

Lugol’s Iodine-Enhanced Micro-CT: A Potential 3-D Imaging Method for Detecting Tongue Squamous Cell Carcinoma Specimens in Surgery

et al. 2020

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Background: A positive surgical margin (PSM) following oral cancer resection results in local recurrence and poor prognosis. Mono-block tumor specimens, especially from the tumor base, are difficult to evaluate. This inaccurate sampling ultimately leads to a false pathological diagnosis. Lugol's iodine (I 2-IK)-enhanced micro-CT is an emerging method to image tumor specimens. This study explores the feasibility of I 2-IK-enhanced micro-CT to evaluate the surgical margin for tongue squamous cell carcinoma (TSCC) specimens and to further seek optimal staining parameters. Methods: Rabbit tongue tissues and human TSCC samples were imaged via I 2-IKenhanced micro-CT. The optimal I 2-IK concentration and staining time were determined before clinical application using tissue shrinkage, micro-CT image quality, and effect on pathological diagnosis as assessment criteria. Next, 6 TSCC specimens were used to verify the process feasibility of surgical margin imaging with the optimal parameters. Finally, the possible reason by which I 2-IK could enhance micro-CT imaging was validated in vitro. Results: I 2-IK staining influenced specimen shrinkage, micro-CT image quality, and pathological image quality in a concentration-and time-dependent manner. After comprehensively considering these indicators, 3% I 2-IK staining for 48 and 12 h were found to be optimal for rabbit tongue tissues and TSCC samples, respectively. This method could provide a detailed 3-D structure of TSCC samples compared with H&E sections. Moreover, tumor and normal tissues could be differentiated by their glycogen content, which has high affinity with I 2-IK. Conclusions: I 2-IK-enhanced micro-CT could, thus, indicate the tumor margin and assist pathological sampling in patients with TSCC postoperation.

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Kinetics of indocyanine green: Optimizing tumor to normal tissue fluorescence in image‐guided oral cancer surgery applications

Cited by 15 publications

References 36 publications

The feasibility of locating the affected bone of BRONJ with indocyanine green

The feasibility of locating the affected bone of BRONJ with indocyanine green

Comparative study on the diagnostic value of intravenous/ peritumoral injection of indocyanine green for metastatic lymph node location in patients with head and neck squamous cell carcinoma (HNSCC)

Lugol’s Iodine-Enhanced Micro-CT: A Potential 3-D Imaging Method for Detecting Tongue Squamous Cell Carcinoma Specimens in Surgery

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