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Objective: To explore the value of indocyanine green fluorescence imaging in tumor localization and lymph node dissection in totally laparoscopic distal gastrectomy. Methods: A retrospective cohort study was used. The clinical and pathological data of 126 patients with distal gastric cancer diagnosed through gastroscopy and pathology dated from August 2017 to August 2019 in Peking University Cancer Hospital & Institute was collected. Among these 126 patients, 62 patients underwent laparoscopy with indocyanine green-labeled near-infrared fluorescence (observation group), and 64 patients underwent conventional laparoscopy (control group). The effects of preoperative indocyanine green-labeled, intraoperative endoscopic positioning and lymph node dissection were compared and evaluated between the two groups. Result: The distance of proximal incision margin was measured in patients with stage T1-2 gastric cancer. The observation group vs. the control group: (4.92±1.65 cm vs. 4.76±1.66 cm, P=0.671). Number of second station lymph node dissection of patients with stage T3-4 gastric cancer in the observation group vs. the control group: (11.09±6.19 vs. 8.89± 4.35, P=0.049); the number of damaged lymph nodes in the observation group vs. the control group: (0.74±0.46 vs. 1.27±1.22, P= 0.009). Conclusions: The preoperative indocyanine green-fluorescence imaging in patients with stage T1-2 gastric cancer can accurately mark the tumor boundary, and its tumor localization effect is comparable with intraoperative gastroscopy in the surgery, which can guide the decision of the appropriate resection line during total laparoscopic surgery. Indocyanine green in the lymphatic navigation of T3-4 gastric cancer can guide the operation precisely and completely in the lymph node dissection, increase the number of lymph nodes dissection, and reduce the damage of lymph nodes during the operation.
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Objective@#To systematically evaluate the diagnostic value of optical imaging combined with indocyanine green (ICG)-guided sentinel lymph node (SLN) biopsy in gastric cancer, and to identify potential factors that would influence diagnostic accuracy.@*Methods@#Study was carried out by searching the electronic database of PubMed, Embase, Medline, Web of Science, and the Cochrane Library with keywords as "gastric/stomach" and "cancer/carcinoma/tumor/tumour/adenocarcinoma/neoplasm" and "sentinel lymph node" and "near-infrared/NIR or fluorescent imaging" and "indocyanine green/ICG" . Literature inclusion criteria: (1) gastric cancer clinical stage was cT0-3; (2) clinical stage determined by at least 2 kinds of imaging modalities; (3) optical imaging (near-infrared or fluorescence imaging) combined with ICG-guided SLN biopsy; (4) prospective study to predict lymph node metastasis; (5) intraoperative or postoperative pathology for all lymph nodes removed; (6) patients number in the literature >10 cases. Exclusion criteria: (1) patients with a history of ICG allergy or chemoradiotherapy; (2) previous history of endoscopic mucosal resection or endoscopic submucosal dissection; (3) patients with a variety of gastrointestinal tumor; (4) case reports, conference abstracts, clinical guidelines, editorials, reviews, meta-analysis and correspondence letters; (5) in vitro or animal experiments; (6) insufficient diagnostic efficacy data. The meta-analysis was performed in the Stata12.0 software using the "bivariate mixed-effects model" combined with the "midas" command to pool the data. Information such as true positive value, false positive value, false negative value, and true negative value of each included articles were extracted. The literature quality assessment map was drawn to describe the overall quality of the articles; the heterogeneity analysis was performed with the forest map, with P<0.01 considered as statistical significance; the funnel plot was used to describe publication bias, with P<0.1 considered as statistically significant. Area under curve (AUC) of summary receiver operator characteristic (SROC) was used to describe the diagnostic accuracy and the AUC closer to 1 indicated higher diagnostic accuracy. If there was heterogeneity (I2>50%) among studies, regression analysis and subgroup analysis were performed. P<0.05 was considered as statistically significant.@*Results@#A total of 15 studies (1020 patients) were included. The optical imaging contained near-infrared (NIR) and fluorescent imaging (FI). The diagnostic value of optical imaging combined with ICG-guided SLN biopsy in gastric cancer was as follows: the pooled sensitivity (Sen) was 0.95 (95% CI: 0.82 to 0.99), specificity (Spe) was 1.00 (95% CI: 0.92 to 1.00), positive likelihood ratio (PLR) was 30.39 (95% CI: 9.14 to 101.06), negative likelihood ratio (NLR) was 0.05 (95% CI:0.01 to 0.20), diagnostic odds ratio (DOR) was 225.54 (95% CI: 88.81 to 572.77), AUC was 1.00 (95% CI: 0.99 to 1.00), threshold value was sensitivity=0.95 (95% CI: 0.82 to 0.99) and specificity=1.00 (95% CI: 0.92 to 1.00). Deeks method revealed DOR funnel plot of SLN biopsy was not asymmetrical obviously with significant difference (P=0.01), which indicated remarkable publishing bias. Meta-subgroup analysis showed that compared to FI, NIR imaging had higher sensitivity (0.98 vs. 0.73); compared to 0 minutes, optical imaging performed 20 minutes after ICG injection had higher sensitivity (0.98 vs. 0.70); compared to mean detected number of SLN of 4, mean detected number≥4 had higher sensitivity (0.96 vs. 0.68); compared to HE stain, immunohistochemistry + HE had higher sensitivity (0.99 vs. 0.84); compared to subserous injection of ICG, submucosa injection of ICG had higher sensitivity (0.98 vs. 0.40); compared to injection of 5 g/L ICG, 0.5 g/L and 0.05 g/L had higher sensitivity (0.98 vs. 0.83); compared to cT2-3 tumor, early stage (cT1) tumor had higher sensitivity (0.96 vs. 0.72); compared to ≤ enrolled 26 cases in the study, > 26 cases had higher sensitivity (0.96 vs. 0.65); compared to papers before 2010, papers after 2010 had higher sensitivity (0.97 vs. 0.81); whose differences were all significant. Sensitivity differences between mean tumor diameter of ≤30 cm and >30 cm, open surgery and laparoscopic surgery, lymph node regional dissection and retrieved dissection were not significant (all P>0.05).@*Conclusions@#Optical imaging combined with ICG-guided SLN biopsy is clinically feasible, and especially suitable for early gastric cancer. However, the ICG being used in current studies may be overdosed. Higher sensitivity may be achieved from NIR imaging when compared with FI method.
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The recurrence rate of primary hepatocellularcarcinoma is very high,and repetitive resection is still the besttreatment for operable recurrent hepatocellular carcinoma.Indocyanine green(ICG) has been widely used andpopularized in resection of hepatocellular carcinoma,providesmore possibilities and diversity for the surgical treatment ofrecurrent hepatocellular carcinoma. Combined withpreoperative imaging,three-dimensional imaging technologyand intraoperative ultrasound,ICG can effectively improve theradical and accuracy of the operation for recurrent hepatocellular carcinoma. ICG-guided hepatectomy isappropriate for the new concept and technical system of liversurgery advocated by modern medical model, and realizesfunctional and anatomical hepatectomy for recurrenthepatocellular carcinoma.
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It is difficult to detect micrometastasis of liver cancer with conventional imaging techniques,which leads to high recurrence rate after surgical excision in patients with colorectal cancer liver metastasis.The emergence of indocyanine green fluorescence imaging technology solves this problem.This article reviews the mechanism of this new technology,its clinical application in liver cancer resection and also discussed the advantages and limitations for indocyanine green fluorescence imaging technology.
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Objective To study the optimal timing of preoperative injection of indocyanine green in laparoscopic liver tumor resection under indocyanine green fluorescent navigation to obtain the most satisfactory fluorescence imaging effects.Methods 60 patients with liver tumors who underwent laparoscopic hepatectomy from April 2017 to October 2018 were retrospectively studied on the intraoperative fluorescence imaging effects.A simple grading of the fluorescence imaging effects was developed.The ICG R15 and preoperative injection times of ICG were correlated with the intraoperative fluorescence imaging effects.Results Of 60 patients with liver tumors,59 patients underwent laparoscopic liver resection and one patient was converted to open surgery.The overall satisfaction rate of intraoperative fluorescence imaging was 73.4％ (44/60).In the patients with an ICG R15 rate ≤ 7％,it was easier to obtain good fluorescence imagings when the preoperative administration time was longer than 48 hours.Even when the preoperative administration time was longer than 5 days,satisfactory fluorescence imaging effect could still be obtained in these patients.In the patients with an ICG R15 rate ＞ 7％,intraoperative fluorescence imagings were unsatisfactory when the administration time was less than 6 days.Relative better imagings were obtained in these patients when the preoperative administration time was more than 6 days.Conclusions When the pre-operative ICG injection dose was not changed,the preoperative administration time should be adjusted according to the value of the ICG R15 to obtain better intraoperative fluorescence imaging effects of the liver tumors.The optimal timing needs to be further studied by a large case study.
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Surgery is so far the most widely used and effective treatment of neoplastic diseases.However,residual tumour cells during surgery remain a major trigger of cancer recurrence and matastasis.Although intraoperative rapid pathological R0 resection can be achieved based on preoperative imageological examination,but for small satellite lesions and the naked eye can not find the error quickly and so often cause pathological presence of residual tumour cells.Thus,quick and accurate identification of residual cancer cells is crucial for prognosis of cancer patients.Indocyanine green (ICG) is a new type of fluorochrome that can stain tumours under the near-infrared fluorescence during surgery,the paper will be reviewed latest developments in the reagent for fluorescence in tumours.
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Background and purpose:Sentinel lymph node biopsy has replaced axillary lymph node dissec-tion as the standard staging procedure in early breast cancer patients with clinically negative axillary lymph nodes. It is a critical step for staging and treatment. This study investigated the localization effect of a novel tracer for breast cancer sentinel lymph node biopsy [indocyanine green (ICG)-rituximab (R)], using the hind limb drainage in mice as an animal model.Methods:For exploring the optimal dose and imaging time, different doses of ICG-R were injected subcutane-ously to the dorsum of the foot in the BALB/c mice. Then the lfuorescence vasculature imaging instrument was used continuously to observe the popliteal fossa lymph node (as sentinel lymph node) from the injection to 3 h after injection. For exploring the sustained localization effect, the optimal dose of ICG-R was injected and the imaging instrument was used from imaging to 24 h after injection.Results:The time from injection to imaging and the time from injection to the optimal imaging were shortened with the increased doses, and the imaging rate of the second or third level node increased accordingly. The best dosage of the novel tracer was 0.12 μg (dosage of indocyanine green) and the time from injection to the optimal imaging was about 34 min. After the observation for 24 h, the imaging rate of sentinel lymphnode was maintained at 100%, and the imaging rate of the second and the third level lymph node increased from 0% to 20% and 10%, respectively.Conclusion:ICG-R could clearly locate the sentinel lymph node. There is no imaging of the second level lymph node within 6 h. The novel tracer has high value in the clinical application.
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PURPOSE: To compare the surgical outcomes and complications of triamcinolone acetonide (TA) with those of indocyanine green (ICG) staining of the internal limiting membrane (ILM) during idiopathic macular hole surgery. METHODS: Twenty-four eyes of 23 consecutive patients with an idiopathic macular hole underwent vitrectomy, ILM peeling, and intravitreal gas injection. For enhanced visualization of ILM, ICG was used in 13 eyes and TA in the remaining 11 eyes. Functional and anatomical success rates and surgical complications were compared between the groups. RESULTS: The mean follow-up periods were 10.8 months (ICG group) and 7.5 months (TA group). Best corrected visual acuity increased by two or more lines in 10 eyes (76.9%) of the ICG group and in eight eyes (72.7%) of the TA group (P=1.000). Anatomical closure after the first surgery was achieved in 10 eyes (76.9%) of the ICG group and in all 11 eyes of the TA group (100%) (P=0.223). Postoperative atrophic changes in the retinal pigment epithelium (RPE) in the macular hole bed was found in two eyes of the ICG group and in three eyes of the TA group. All of these (5 eyes) showed the photoreceptor outer segment defect in the closed macular areas by optical coherence tomography and had a postoperative best corrected visual acuity of 0.3 or less. CONCLUSIONS: In view of the potential toxicities of ICG, TA appears to be a promising alternative adjuvant for ILM peeling during macular hole surgery. However, postoperative RPE atrophy was detected as a postoperative complication in both the ICG and TA groups. Further study is needed to evaluate the TA toxicity in macular hole surgery.
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Humans , Atrophy , Follow-Up Studies , Indocyanine Green , Membranes , Postoperative Complications , Retinal Perforations , Retinal Pigment Epithelium , Tomography, Optical Coherence , Triamcinolone Acetonide , Triamcinolone , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To determine experimentally the effectiveness of photodynamic therapy (PDT) with indocyanine green (ICG) dye in the treatment of choroidal neovascularization. METHODS: Following the creation of choroidal neovascularization in the retina of 18 pigmented rats (36 eyes), and ICG dye injection (10 mg/kg) in 18 of the eyes, the authors performed PDT, at intensity of 60 mW, spot size of 2.0 mm, and duration of 20 seconds within 2 minutes after ICG dye injection. 0ne, 4, 6, and 8 weeks after PDT, the authors examined the retina for any signs of regression through angiogram and light microscope. RESULTS: When authors conducted PDT after injecting ICG dye into pigmented rats, there was no significant damage to retina when the intensity was set at 60mW with duration of 10 or 20 seconds. Choroidal neovascularization was found in 18 eyes after argon laser photocoagulation, and regression of neovascularization was confirmed through angiogram and pathologic examination after PDT was performed with ICG dye. Pathologic views revealed significant fibrosis and fibrinoid necrosis. The control group consisting of 18 eyes in which no diode laser photocoagulation was performed, showed no regression of choroidal neovascularization. CONCLUSIONS: PDT with ICG dye was found to be quite effective in the treatment of choroidal neovascularization.
Subject(s)
Animals , Rats , Argon , Choroid , Choroidal Neovascularization , Fibrosis , Indocyanine Green , Lasers, Semiconductor , Light Coagulation , Necrosis , Photochemotherapy , RetinaABSTRACT
The choroidal vascular structure in macula is anatomically different from that in other region. And choroidal venous drainage in macula represents various types. This study attempted to classify the choroidal venous drainage in macula and focused on the relationship between the choroidal venous drainage type and a disease involving macula, esp. age-related macular degeneration(ARMD). The authors performed indocyanine green(ICG) angiography in 115 eyes (93 patients) without macular disease and in 31 eyes (24 patients) with ARMD, which were presented with choroidal new vessels. The choroidal venous drainage in macula was classified as 4 types. They were superotemporal drainage, inferotemporal drainage, horizontal watershed, and irregular type. The most common type of choroidal venous drainage was horizontal watershed type which was showed in 55 eyes (48%) without macular diease and 15 eyes (48%) with ARMD. Any relationship between a type of choroidal venous, drainage and ARMD was not found.