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- Title
Correlation of pathological examination with indocyanine green (ICG) intensity gradients: a prospective study in patients with liver tumor.
- Authors
She, Wong Hoi; Chan, Miu Yee; Tsang, Simon Hing Yin; Dai, Wing Chiu; Chan, Albert Chi Yan; Lo, Chung Mau; Cheung, Tan To
- Abstract
Background: Intraoperative indocyanine green (ICG) fluorescence imaging has been shown to be a new and innovative way to illustrate the optimal resection margin in hepatectomy for hepatocellular carcinoma. This study investigated its accuracy in resection margin determination by looking into the correlation of ICG intensity gradients with pathological examination results of resected specimens. Methods: This was a prospective, single-center, non-randomized controlled study. Patients who had liver tumors indicating liver resection were recruited. The hypothesis was that the use of intraoperative near-infrared/ICG fluorescence imaging would be a promising guiding tool for removing hepatocellular carcinoma with a better resection margin. Patients were given ICG (0.25 mg/kg) 1 day before operation. Resected specimens were inspected under a fluorescent imaging system. Biopsies were taken from tumors and normal tissue. Color signals obtained from ICG fluorescence imaging were compared with biopsies for analysis. Results: Twenty-two patients were recruited for study. The median size of their tumors was 2.25 cm. One patient had resection margin involvement. Under ICG fluorescence, the tumors typically lighted up as yellow color, wrapped by a zone of green color. Tumors of 17 patients (77.3%) displayed yellow color and were confirmed malignancy, while tumors of 12 patients (54.5%) displayed green color and were confirmed malignancy. Receiver operating characteristic curve was used to measure the sensitivity and specificity of the green color to look for a clear resection margin. The area under the curve was 85.3% (p = 0.019, 95% confidence interval 0.696–1.000), with a sensitivity of 0.706 and specificity of 1.000. Conclusion: The use of ICG fluorescence can be helpful in determining resection margins. Resection of tumor should include complete resection of the green zone shown in the fluorescence image.
- Subjects
HONG Kong (China); LIVER tumors; FLUORESCENT dyes; BIOPSY; CANCER relapse; RECEIVER operating characteristic curves; DIAGNOSTIC imaging; FISHER exact test; CANCER patients; NEAR infrared spectroscopy; DESCRIPTIVE statistics; CYTOCHEMISTRY; CHI-squared test; INDOLE compounds; SURGICAL margin; LONGITUDINAL method; METASTASIS; STAINS &; staining (Microscopy); PATHOGENESIS; CONFIDENCE intervals; HEPATECTOMY; COLLECTION &; preservation of biological specimens; DATA analysis software; SENSITIVITY &; specificity (Statistics); PATIENT aftercare
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2024, Vol 38, Issue 6, p3441
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-024-10840-9