Indocyanine green fluorescence imaging in the surgical management of liver cancers: Current facts and future implications

Abstract

Imaging detection of liver cancers and identification of the bile ducts during surgery, based on the fluorescence properties of indocyanine green, has recently been developed in liver surgery. The principle of this imaging technique relies on the intravenous administration of indocyanine green before surgery and the illumination of the surface of the liver by an infrared camera that simultaneously induces and collects the fluorescence. Detection by fluorescence is based on the contrast between the (fluorescent) tumoral or peri-tumoral tissues and the healthy (non-fluorescent) liver. Results suggest that indocyanine green fluorescence imaging is capable of identification of new liver cancers and enables the characterization of known hepatic lesions in real time during liver resection. The purpose of this paper is to present the fundamental principles of fluorescence imaging detection, to describe successively the practical and technical aspects of its use and the appearance of hepatic lesions in fluorescence, and to expose the diagnostic and therapeutic perspectives of this innovative imaging technique in liver surgery.

Different ways to manage indocyanine green fluorescence to different purposes in liver surgery: A systematic review

“…The exact optimal dosage and timing still remains to be defined. 7,29 Technical aspects and historical context of ICG fluorescence are well reported in the review by Reinhart et al, 30 but pathophysiological mechanisms of ICG secretion are not totally elucidated. 31 Possible uses in oncological surgery are summarized in two reviews.…”

“…7,29 On the other side, many advantages are described in detection of small nodules unknown before surgery with a statistical significant difference compared to intra-operative ultrasound. 9,13,19,21 Ishizawa et al 9 showed in their report that 13% of lesions were not evident unless observed by ICG fluorescent imaging.…”

“…[1][2][3][4][5][6] These fluorescence imaging techniques are based on the administration of indocyanine green (ICG), a soluble dye which emits a fluorescent light when illuminated by an infrared laser source. 7 ICG has also been used in the last decades to evaluate hepatic function before liver surgery. 8 The application of the fluorescent properties of ICG for liver neoplasms identification and characterization was also recently investigated.…”

Clinically compatible flexible wide-field multi-color fluorescence endoscopy with a porcine colon model

“…ICG is a fluorescent marker that is excited at a wavelength between 600 and 900 nm to emit maximum fluorescence at 810 nm in water and 830 nm in blood. ICG was particularly used in previous studies [13,17] to improve lymph node mapping and enhance tumor contrast. Infrared fluorescence endoscopy with ICG has been used to observe GI vascular structure and may provide precancerous information [12].…”

Fluorescence-Guided Surgery: The Quest for Precision

“…Removal of intracranial gliomas under 5-ALA guidance has demonstrated that the real extension of the tumour is likely to be beyond that identified by MRI (1). Equally good, several research articles have attested to the added value of ICG/NIR for precisely locating liver tumours, intraoperatively (2). Furthermore, boosting precision of cancer localization can be achieved by selective targeting where the fluorophore is bound to a molecule that has avidity for certain neoplastic tissue.…”