Feasibility of real‐time near‐infrared indocyanine green fluorescence endoscopy for the evaluation of mucosal head and neck lesions

Abstract

BackgroundThe purpose of this study was to explore the feasibility and potential drawbacks of near‐infrared (NIR) endoscopy with indocyanine green (ICG) to examine mucosal head and neck lesions.MethodsNIR ICG endoscopy was applied to image head and neck cancer epithelium in vivo. The evaluation of the ICG videos was performed off‐line independently by 2 evaluators and blinded with respect to final histopathological results from biopsies taken as the gold standard.ResultsForty percent of the lesions from 55 patients were histologically malignant. ICG positivity showed a sensitivity, specificity, and accuracy to be related to a malignant tumor of 90.5%, 90.9%, and 89.1%, respectively. The kappa index for the interobserver assessment showed a 94.4% agreement for the assessment of the ICG positivity. Side effects of the NIR ICG endoscopy did not arise.ConclusionNIR ICG endoscopy in patients with mucosal head and neck lesions was feasible and safe. It might help intraoperatively to differentiate benign from malignant lesions. © 2016 Wiley Periodicals, Inc. Head Neck 39: 234–240, 2017

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

“…ICG fluorescence imaging is an emerging technology that has been increasingly used in oncologic surgery . Its current primary uses are guiding tumor resections and locating sentinel lymph nodes .…”

“…In head and neck oncology, the first application of ICG imaging for oral and oropharyngeal cancers was applied to display tumor border in 2013 . Then, intraoperative ICG imaging was implemented to differentiate benign lesions from tumors and locate sentinel lymph nodes . However, all above studies were carried out on visual observation which is difficult to set up a standard to distinguish cancerous tissue from surrounding tissue.…”

“…Particularly, whether NIF ICG imaging can distinguish tumor from normal tissue depends on injection dose and observation time point. Actually, there were two reports studying ICG dynamic NIF imaging in head and neck tumor based on visual observation . However, statistically significant difference between tumor and normal tissue cannot be obtained to establish a standard without quantifying fluorescence intensity.…”

Perspectives, potentials and trends of ex vivo and in vivo optical molecular pathology

“…However, only few markers are certified for in vivo use. They include fluorescein (mainly as its derivative fluorescein isothiocyanate), 5‐aminolevulinic acid (5‐ALA) and indocyanine green (ICG) . 5‐ALA is metabolized in tumors to protoporphyrin IX which can be detected by its red fluorescence upon excitation with blue light.…”

Indocyanine green–assisted dental imaging in the first and second near‐infrared windows as compared with X‐ray imaging

“…Indocyanine green (ICG), approved by the U.S. Food and Drug Administration (FDA) for human angiography, is widely used for fluorescence imaging in cancer surgery and microvascular reconstructive surgery by visualizing critical structures, for example, the vascular pedicle and lymph node . In our previous studies, we used a rat model to demonstrate the feasibility of the ICG‐assisted fluorescence dental imaging in the NIR I window (700−950 nm) with a low‐cost CCD interlaced scan camera …”