Intraoperative Near-Infrared Fluorescence Imaging with Indocyanine Green for Identification of Gastrointestinal Stromal Tumors (GISTs), a Feasibility Study

Abstract

Background: Optimal intraoperative tumor identification of gastrointestinal stromal tumors (GISTs) is important for the quality of surgical resections. This study aims to assess the potential of near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) to improve intraoperative tumor identification. Methods: Ten GIST patients, planned to undergo resection, were included. During surgery, 10 mg of ICG was intravenously administered, and NIRF imaging was performed at 5, 10, and 15 min after the injection. The tumor fluorescence intensity was visually assessed, and tumor-to-background ratios (TBRs) were calculated for exophytic lesions. Results: Eleven GIST lesions were imaged. The fluorescence intensity of the tumor was visually synchronous and similar to the background in five lesions. In one lesion, the tumor fluorescence was more intense than in the surrounding tissue. Almost no fluorescence was observed in both the tumor and healthy peritoneal tissue in two patients with GIST lesions adjacent to the liver. In three GISTs without exophytic growth, no fluorescence of the tumor was observed. The median TBRs at 5, 10, and 15 min were 1.0(0.4–1.2), 1.0(0.5–1.9), and 0.9(0.7–1.2), respectively. Conclusion: GISTs typically show similar fluorescence intensity to the surrounding tissue in NIRF imaging after intraoperative ICG administration. Therefore, intraoperatively administered ICG is currently not applicable for adequate tumor identification, and further research should focus on the development of tumor-specific fluorescent tracers for GISTs.

Excision of a gastrointestinal stromal tumour in a dog using short‐wave infrared fluorescence imaging and indocyanine green

“…To ensure adequate surgical margin, SWIR imaging has been applied in human medicine (Kalisvaart et al., 2022 ). Not only in human medicine, SWIR imaging is also used in veterinary medicine, to ensure the complete removal of tumours (Kim and Lee, 2022 ).…”

“…Complete intestinal resection and anastomosis are the main surgical treatments for intestinal neoplasia including GIST (Tobias, Karen M., & Johnston, S. A., 2017). Generally, at intestinal tumour surgery, it is advised to perform resection with approximately 3 cm margin of normal intestinal tissue of the cranial and caudal direc- To ensure adequate surgical margin, SWIR imaging has been applied in human medicine (Kalisvaart et al, 2022). Not only in human medicine, SWIR imaging is also used in veterinary medicine, to ensure the complete removal of tumours (Kim and Lee, 2022).…”

Latest Advances in the Management of Pediatric Gastrointestinal Stromal Tumors

“…Future development in the surgical management of GIST may be characterized by the search for the application of fluorescence markers to improve surgical procedures. To date, indocyanine green has proved to be inefficient in this matter [ 99 ]. Another promise is the future widespread use of 3D planning and augmented reality to better plan and execute the surgery, especially in tumors of difficult localization, including vessel- and neuroinvasive tumor.…”