Performance of two clinical fluorescence imaging systems with different targeted and non-targeted near-infrared fluorophores: a cadaveric explorative study

Abstract

IntroductionNear-infrared (NIR) fluorescence-guided surgery is increasingly utilized in humans and pets. As clinical imaging systems are optimized for Indocyanine green (ICG) detection, the usage of targeted dyes necessitates the validation of these systems for each dye. We investigated the impact of skin pigmentation and tissue overlay on the sensitivity of two NIR cameras (IC-FlowTM, VisionsenseTM VS3 Iridum) for the detection of non-targeted (ICG, IRDye800) and targeted (AngiostampTM, FAP-Cyan) NIR fluorophores in an ex vivo big animal model.MethodsWe quantitatively measured the limit of detection (LOD) and signal-to-background ratio (SBR) and implemented a semi-quantitative visual score to account for subjective interpretation of images by the surgeon.ResultsVisionsenseTM VS3 Iridum outperformed IC-FlowTM in terms of LOD and SBR for the detection of all dyes except FAP-Cyan. Median SBR was negatively affected by skin pigmentation and tissue overlay with both camera systems. Level of agreement between quantitative and semi-quantitative visual score and interobserver agreement were better with VisionsenseTM VS3 Iridum.ConclusionThe overlay of different tissue types and skin pigmentation may negatively affect the ability of the two tested camera systems to identify nanomolar concentrations of targeted-fluorescent dyes and should be considered when planning surgical applications.

Case report: video-assisted thoracoscopic surgery for pulmonary arteriovenous malformation using near-infrared fluorescence with indocyanine green

“…Consistent with previous studies, the contrast between the nodules and the surrounding tissues was less obvious at lower SBR. Furthermore, the fluorescent signal was considered detectable with SBR ≥ 1.5 [ 24 , 25 ]. Therefore, the intraoperative real-time NIF imaging system successfully navigated surgeons to find the PAVM.…”

Indocyanine Green (ICG) Fluorescence-Assisted Open Surgery Using the Rubina® Lens System in the Pediatric Population: A Single-Center Prospective Case Series

“…No drains were left at the end of the procedure. The postoperative course was uneventful, without any recurrence or complication at the median follow-up of 11 months (range [8][9][10][11][12].…”

“…The comparative analysis showed significantly lower The matched control group, without ICG-NIRF assistance, included nine boys with bilateral gynecomastia. The median patient's age at surgery was 14.6 years-old (range [12][13][14][15][16]. Five out of the nine patients (55.5%) developed postoperative seroma in the breast region, managed with needle aspiration in an outpatient setting (Clavien-Dindo 2).…”

“…The matched control group, without ICG-NIRF assistance, included five boys with a preauricular fistula. The median patient's age at surgery was 9.8 years-old (range [6][7][8][9][10][11][12][13][14]. Two out of the five patients (40%) developed postoperative complications, including surgical site infection and serous discharge from the surgical site, both managed with antibiotic therapy (Clavien-Dindo 2).…”

“…To prevent complications or recurrence, the surgery must be as accurate and precise as possible. Fluorescence-guided surgery (FGS) consists of a fluorescent dye, a light source (laser or LED to excite the dye at a specific wavelength) and a detection system such as a camera collecting the light emitted from the dye at a specific wavelength [11,12]. Indocyanine green (ICG) is one of the most used dyes in surgery thanks to its excellent safety profile and short half-life of 3-4 min.…”