The Advantages of Indocyanine Green Fluorescence Imaging in Detecting and Treating Pediatric Hepatoblastoma: A Preliminary Experience

Abstract

Background: Currently, indocyanine green (ICG) fluorescence imaging enables radical surgical resection in hepatoblastoma (HB) and has beneficial uses; however, its usage in pediatric patients is still limited.Methods: From 2015 to 2019, 17 hepatoblastoma patients underwent 22 fluorescence-guided surgery using ICG. ICG (0.3 mg/kg) was intravenously injected 24–48 h before the operation. With ICG/NIR camera, intraoperative identification of biological structures and demarcation of mass were conducted.Results: ICG fluorescence-guided surgery was performed for hepatoblastoma in 22 cases: 16, 1, and 2 cases underwent anatomic resection, partial hepatectomy, and liver transplantation, respectively. Six patients accompanied lung metastasis at the time of surgery, and two patients underwent lung surgery using ICG. The median interval from ICG injection to surgery was 38.3 h (range, 20.5–50.3 h). The median tumor size was 36.5 mm (range, 2–132 mm). According to the pathologic finding, the median safety margin was secured for 6 mm (range, 0–11 mm) and there was no residual finding at the liver at the follow-up computed tomography (CT).Conclusions: ICG fluorescence imaging in children with HB was feasible and safe for tumor demarcation and enhancing the accuracy of radical tumor resection.

Tumor-Background Ratio is an effective method to identify tumors and false-positive nodules in indocyanine-green navigation surgery for pediatric liver cancer

“…If these areas are located at the junction of the tumor and normal liver tissue, it will lead to a decrease in the visibility of the tumor location and boundary. Cho et al also reported 2 cases of HB without fluorescence imaging after chemotherapy, of which 1 case had tumor necrosis of 80%, and the other had mostly calcification and osseous differentiation ( 14 ). Therefore, for children with HB undergoing preoperative chemotherapy, this technique still has some limitations.…”

“…As some of the tumors were far from the surface of the liver, and the tumor cell necrosis rate was as high as 95%, so most of the tumor tissue did not have fluorescence, which is consistent with the reports in the literature. Although ICG can image well in children with liver malignant tumors, when the distance from the tumor to the surface of the liver exceeds 1 cm, the effectiveness of fluorescence imaging decreases significantly ( 13 , 14 , 20 , 25 ). Therefore, a deep location of the tumor can lead to low fluorescence or false negative events.…”

Combined Use of Three-Dimensional Construction and Indocyanine Green-Fluorescent Imaging for Resection of Multiple Lung Metastases in Hepatoblastoma

“…Indocyanine green (ICG) emits light with a peak at approximately 840 nm when irradiated with near-infrared light (750-810 nm). ICG-guided surgery has been widely applied to detect both liver and metastatic site lesions in HB because of its unique properties, especially its ability to accumulate in the liver [15][16][17]. When ICG is administered intravenously, it is taken up by hepatocytes and excreted in the bile.…”

Deploying Indocyanine Green Fluorescence-Guided Navigation System in Precise Laparoscopic Resection of Pediatric Hepatoblastoma

“…Since HB possesses similar features to hepatocellular carcinoma, the ICG fluorescence-guided system has been increasingly applied in HB surgery [ 7 ]. Subsequent reports of ICG fluorescence-guided surgery for HB mainly include local tumor, liver, or lung metastasis lesions, residual, and recurrence tumors [ 8 , 9 , 10 , 11 ]. Yamada et al and Cho Y.J.…”

“…Yamada et al and Cho Y.J. et al applied ICG fluorescence imaging as a method of surgical navigation in detecting HB lesions and successfully demonstrated its safety and usefulness [ 9 , 11 ]. Meanwhile, the high sensitivity of ICG imaging in guiding pulmonary metastasectomy was revealed by Misa et al through their study [ 12 ].…”