The identification of sub-centimetre nodules by near-infrared fluorescence thoracoscopic systems in pulmonary resection surgeries

Abstract

NCT02611245.

Intraoperative fluorescence imaging in thoracic surgery

“…These results with an ICG dose of 5 mg/kg and imaging 24 hours after infusion have recently been replicated by Mao et al In their study, NIR imaging with second window ICG identified 68 of 76 nodules in 36 patients. All nodules not detected with imaging were at least 1.3 cm deep to the pleural surface.…”

A narrative review of indocyanine green near-infrared fluorescence imaging technique: a new application in thoracic surgery

“…Okusanya et al injected ICG (5 mg/kg) intravenously 24 h before surgery, the nodule detection rate was 88.9% [16/18], the NIRF imaging also identified five additional sub-cm nodules, three metastatic adenocarcinomas and two metastatic sarcomas (6). Mao et al showed that the mean near-infrared signal to background ratio of the pulmonary nodules by intravenous ICG (5 mg/kg) was 3.29±1.81, the sensitivity and positive predictive value of ICG NIRF imaging were 88.7% and 92.6%, respectively (7). The sensitivity of this method is not affected by factors such as nodules size, metabolic activity, histological type, etc., and small nodules that are neglected by CT can be also visualized; however, this technique has limitations on the depth of nodules, which is reported in the literature as 1.3-2.0 cm (4,6).…”

Intraoperative molecular imaging—a bright navigator for thoracic surgeons in the era of limited resection

“…Several kinds of molecules have been used to detect tumors intraoperatively. Indocyanine green (ICG) is one of the most widely used agents to detect many kinds of malignancies, including NSCLCs, together with near-infrared (NIR) fluorescence imaging (11,12). Although ICG is not a tumor-specific fluorescence dye, it accumulates in certain types of tumors because of the enhanced permeability and retention effect (13).…”

“…Although ICG is not a tumor-specific fluorescence dye, it accumulates in certain types of tumors because of the enhanced permeability and retention effect (13). Intraoperative molecular imaging using ICG is reportedly able to detect small tumors in the lung (12,14); however, hyperplastic or inflammatory nodules may cause false-positive results (12) and ICG cannot distinguish between the tumor itself and the inflamed tissue around the tumor (11). Another potentially useful agent is the folate receptor (FR) targeted NIR tracer (OTL0038) that targets the FR-alpha that is expressed in 90% of pulmonary adenocarcinomas and 70% of squamous cell carcinomas (15,16).…”

“…Another question is whether this molecular imaging can detect GGO lesions other than lung adenocarcinomas, as many types of diseases may present with GGO on computed tomography (CT) imaging, including infection, collagen vascular disease, drug toxicity, fibrosis, and pulmonary metastasis from malignant melanoma (although this is rare) (21). In addition, further challenging is essential to improve this technique so that it can detect deeper lesions from the parenchyma surface in vivo, although intraoperative molecular imaging using ICG has the same issue (12) The widespread use of CT examination, especially in developed countries, enables the early detection of small-sized lung cancers, including AIS. As not all lesions detected in the lung by CT imaging are malignant, several biomarkers that may be able to distinguish lung cancers from benign diseases have been suggested (22).…”