Intraoperative Near-infrared Fluorescence (NIR) Imaging With Indocyanine Green (ICG) Can Identify Bone and Soft Tissue Sarcomas Which May Provide Guidance for Oncological Resection

Abstract

Background: Complete excision of sarcomas to maximize function without compromising the oncological outcome can be challenging. The aim of this study was to investigate the feasibility and potential drawbacks of near-infrared (NIR) fluorescence imaging with indocyanine green during resection of bone and soft tissue sarcomas. Methods: Eleven patients with high-grade sarcomas were enrolled in the study. All patients received intravenous indocyanine green (75 mg) between 16 and 24 hours before the resection. Sarcomas were resected under NIR guidance and specimens were sent for routine histopathological analysis. Results: Majority of treatment naive tumors demonstrated fluorescence. There were no adverse events from the indocyanine green administration. In 3 cases, the fluorescence was reported by the surgeon to have been of definite guidance leading to further tissue resection to improve the margin. Conclusion: This is the first report of NIR fluorescence guidance in the setting of open sarcoma surgery. The technique is acceptable to patients and surgeons and was able to guide resection. Multicenter studies are required to assess the utility of this technique in a large cohort of patients with regards to quantification of fluorescence, resection guidance, and longer follow-up period.

Investigating the mechanisms of indocyanine green (ICG) cellular uptake in sarcoma

“…The accumulation of ICG within tumours after intravenous administration has been reported across a number of cancer types 35,37,40,45 . It is well known that the preferential tumour cell uptake of ICG is non-specific 45 .…”

“…This was first described in liver tumours, in which both hepatocellular carcinomas and metastatic lesions have been shown to fluoresce 28,29 . The use of ICG for fluorescence guided surgery has since been described in both breast cancer 30 , in which the absence of fluorescence in the surgical bed was predictive of negative margins 31 , ovarian cancer 32 , head and neck cancer 33 , lung cancer 34 and sarcomas 35 . Unlike angiography, in which the ICG is given intraoperatively, the ICG is instead given pre-operatively.…”

MRI after Whoops procedure: diagnostic value for residual sarcoma and predictive value for an incomplete second resection

“…New imaging techniques are required to improve operative planning and the success of the second surgery after a Whoops procedure. This clinical need may perhaps be met by using targeted, fluorescently labeled ligands combined with optical imaging instruments with micron resolution to guide surgical resection, as demonstrated by some preliminary studies [13][14][15]. There are a few recent studies that investigated the value of MRI for the detection of residual tumor after a Whoops procedure.…”

Introducing Fluorescence-Guided Surgery for Pediatric Ewing, Osteo-, and Rhabdomyosarcomas: A Literature Review

“…Only one study describes the use of ICG for various sarcoma resections in 26-to 79year-old adults [40]. They included eleven patients, among which were one OS patient and one pleomorphic RMS patient who received 75 mg ICG 16-24 h before surgery.…”