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

Abstract

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.

The diagnostic value of Near-Infrared Indocyanine Green Imaging for Endometriosis: A systematic review and meta-analysis

“…Turco. et al [33] compared the diagnostic e ciency of conventional WL imaging to ICG imaging during 51 patients with EMs and found that ICG imaging alone and combined with WL imaging showed good results in the intraoperative detection rate of EMs. These inconsistent results make the diagnostic value of ICG imaging uncertain, through the quantitative synthesis of existing homogeneous results can provide more reliable conclusions, this is the main purpose of the present meta-analysis.…”

Efficacy of Dienogest on Pelvic Pain and Dyspareunia: Comprehensive Meta-Analysis and Systematic Review

“…It has high progestational and mild anti-gonadotrophic effects [26][27][28][29]. A previous randomized clinical study shows that oral dienogest reduces pelvic discomfort in women with endometriosis better than in a placebo [6,[30][31][32]. Dienogest was shown to be similarly effective in reducing pelvic pain in clinical studies that compared oral dienogest with gonadotropinreleasing hormone (GnRH) agonists for 16 weeks or 24 weeks in women with endometriosis [13].…”

NIR‐II imaging with ICG for identifying perforators, assessing flap status and predicting division timing of pedicled flaps in a porcine model

“…Nowadays, as an objective, non-invasive and real-time approach, near infrared imaging has attracted much attention [23][24][25][26]. Previous studies have shown that it has been broadly used in lymphangiography, angiography, sentinel lymph nodes, tumor margin detection and so on [27][28][29].…”