Timing of administration of indocyanine green for fluorescence-guided surgery in pancreatic cancer: response to Shirakawa et al

Labib, Peter

doi:10.1186/s12893-020-00881-x

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…The resulting false positive rates, along with the workflow impact necessary for compound administration many hours in advance of the planned surgery, limit the widespread adoption of this method. In addition, with all point in time tumour localisation, timing of ICG administration must be so ICG concentration within the region of interest is at its maximum relative to surrounding tissues and significantly different to any sites of non-malignant trapping [51]. However, exact timings of operations and, especially, the exact timing of intraoperative encounter with the site being labelled by ICG can be uncertain.…”

Section: Icg For Intraoperative Cancer Imaging -Current State Of the Artmentioning

confidence: 99%

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Boland,

Hardy,

Moynihan

et al. 2024

Eur J Nucl Med Mol Imaging

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Colorectal cancer remains a major cause of cancer death and morbidity worldwide. Surgery is a major treatment modality for primary and, increasingly, secondary curative therapy. However, with more patients being diagnosed with early stage and premalignant disease manifesting as large polyps, greater accuracy in diagnostic and therapeutic precision is needed right from the time of first endoscopic encounter. Rapid advancements in the field of artificial intelligence (AI), coupled with widespread availability of near infrared imaging (currently based around indocyanine green (ICG)) can enable colonoscopic tissue classification and prognostic stratification for significant polyps, in a similar manner to contemporary dynamic radiological perfusion imaging but with the advantage of being able to do so directly within interventional procedural time frames. It can provide an explainable method for immediate digital biopsies that could guide or even replace traditional forceps biopsies and provide guidance re margins (both areas where current practice is only approximately 80% accurate prior to definitive excision). Here, we discuss the concept and practice of AI enhanced ICG perfusion analysis for rectal cancer surgery while highlighting recent and essential near-future advancements. These include breakthrough developments in computer vision and time series analysis that allow for real-time quantification and classification of fluorescent perfusion signals of rectal cancer tissue intraoperatively that accurately distinguish between normal, benign, and malignant tissues in situ endoscopically, which are now undergoing international prospective validation (the Horizon Europe CLASSICA study). Next stage advancements may include detailed digital characterisation of small rectal malignancy based on intraoperative assessment of specific intratumoral fluorescent signal pattern. This could include T staging and intratumoral molecular process profiling (e.g. regarding angiogenesis, differentiation, inflammatory component, and tumour to stroma ratio) with the potential to accurately predict the microscopic local response to nonsurgical treatment enabling personalised therapy via decision support tools. Such advancements are also applicable to the next generation fluorophores and imaging agents currently emerging from clinical trials. In addition, by providing an understandable, applicable method for detailed tissue characterisation visually, such technology paves the way for acceptance of other AI methodology during surgery including, potentially, deep learning methods based on whole screen/video detailing.

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Section: Icg For Intraoperative Cancer Imaging -Current State Of the Artmentioning

confidence: 99%

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Boland,

Hardy,

Moynihan

et al. 2024

Eur J Nucl Med Mol Imaging

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“…In many oncological practices, using NIR fluorescence imaging with ICG has become commonplace, both in open surgery and MIS, such as during staging laparoscopy for cancer[ 33 ]. This fact makes ICG the primary available dye with considerable literature support and wide use.…”

Section: Intraoperative Indocyanine Green Fluorescence Guidancementioning

confidence: 99%

Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients

Abdelrahman¹,

El‐Menyar²,

Peralta³

et al. 2023

World J Gastrointest Surg

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Background: Modern surgical medicine strives to manage trauma while improving outcomes using functional imaging. Identification of viable tissues is crucial for the surgical management of polytrauma and burn patients presenting with soft tissue and hollow viscus injuries. Bowel anastomosis after trauma-related resection is associated with a high rate of leakage. The ability of the surgeon’s bare eye to determine bowel viability remains limited, and the need for a more standardized objective assessment has not yet been fulfilled. Hence, there is a need for more precise diagnostic tools to enhance surgical evaluation and visualization to aid early diagnosis and timely management to minimize trauma-associated complications. Indocyanine green (ICG) coupled with fluorescence angiography is a potential solution for this problem. ICG is a fluorescent dye that responds to near-infrared irradiation. Methods: We conducted a narrative review to address the utility of ICG in the surgical management of patients with trauma as well as elective surgery. Discussion: ICG has many applications in different medical fields and has recently become an important clinical indicator for surgical guidance. However, there is a paucity of information regarding the use of this technology to treat traumas. Recently, angiography with ICG has been introduced in clinical practice to visualize and quantify organ perfusion under several conditions, leading to fewer cases of anastomotic insufficiency. This has great potential to bridge this gap and enhance the clinical outcomes of surgery and patient safety. However, there is no consensus on the ideal dose, time, and manner of administration nor the indications that ICG provides a genuine advantage through greater safety in trauma surgical settings. Conclusions: There is a scarcity of publications describing the use of ICG in trauma patients as a potentially useful strategy to facilitate intraoperative decisions and to limit the extent of surgical resection. This review will improve our understanding of the utility of intraoperative ICG fluorescence in guiding and assisting trauma surgeons to deal with the intraoperative challenges and thus improve the patients’ operative care and safety in the field of trauma surgery.

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Timing of administration of indocyanine green for fluorescence-guided surgery in pancreatic cancer: response to Shirakawa et al

Cited by 2 publications

References 8 publications

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Intraoperative near infrared functional imaging of rectal cancer using artificial intelligence methods - now and near future state of the art

Application of indocyanine green in surgery: A review of current evidence and implementation in trauma patients

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