scholarly journals Intraoperative Near-Infrared Fluorescence Guided Surgery Using Indocyanine Green (ICG) for the Resection of Sarcomas May Reduce the Positive Margin Rate: An Extended Case Series

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6284
Author(s):  
Marcus J. Brookes ◽  
Corey D. Chan ◽  
Fabio Nicoli ◽  
Timothy P. Crowley ◽  
Kanishka M. Ghosh ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Positive Margin ◽  
Randomised Control Trial ◽  
High Grade ◽  
Conventional Surgery ◽  
Guided Surgery ◽  
Positive Margin Rate ◽  
Nir Fluorescence ◽  
Fluorescence Guided Surgery

Background: Sarcomas are rare, aggressive cancers which can occur in any region of the body. Surgery is usually the cornerstone of curative treatment, with negative surgical margins associated with decreased local recurrence and improved overall survival. Indocyanine green (ICG) is a fluorescent dye which accumulates in sarcoma tissue and can be imaged intraoperatively using handheld near-infrared (NIR) cameras, theoretically helping guide the surgeon’s resection margins. Methods: Patients operated on between 20 February 2019 and 20 October 2021 for intermediate to high grade sarcomas at our centres received either conventional surgery, or were administered ICG pre-operatively followed by intra-operative NIR fluorescence guidance during the procedure. Differences between the unexpected positive margin rates were compared. Results: 115 suitable patients were identified, of which 39 received ICG + NIR fluorescence guided surgery, and 76 received conventional surgery. Of the patients given ICG, 37/39 tumours fluoresced, and surgeons felt the procedure was guided by the intra-operative images in 11 cases. Patients receiving ICG had a lower unexpected positive margin rate (5.1% vs. 25.0%, p = 0.01). Conclusions: The use of NIR fluorescence cameras in combination with ICG may reduce the unexpected positive margin rate for high grade sarcomas. A prospective, multi-centre randomised control trial is now needed to validate these results.

scholarly journals Response to: “timing of administration of indocyanine green for fluorescence-guided surgery in pancreatic cancer: response to Shirakawa et al.”

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sachiyo Shirakawa ◽  
Hirochika Toyama ◽  
Masahiro Kido ◽  
Takumi Fukumoto
Keyword(s):  
Pancreatic Cancer ◽  
Indocyanine Green ◽  
Hepatic Metastasis ◽  
Peritoneal Metastasis ◽  
Near Infrared ◽  
Staging Laparoscopy ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
Near Infrared Fluorescence Imaging ◽  
White Light Imaging

Abstract This is the response article to correspondence article received for our published article in BMC surgery titled “A prospective single-center protocol for using near-infrared fluorescence imaging with indocyanine green during staging laparoscopy to detect small metastasis from pancreatic cancer”. Peter L. Labib, MBChB pointed out the necessity to administer indocyanine green intravenously in separate timing for detection of metastasis in liver and peritoneum. Preoperative injection is suitable to detect hepatic metastasis and intraoperative injection is reported to be well suited to detect peritoneal metastasis. However, we could not find the usefulness of intraoperative injection of indocyanine green for detecting peritoneal metastasis in cases with staging laparoscopy prior to this study. We employed this study protocol with only preoperative injection of indocyanine green to simplify the procedure with consideration of probably more frequent cases of hepatic metastasis that is difficult to detect with white-light imaging than those of peritoneal metastasis.

scholarly journals One-pot synthesis of water-soluble near-infrared fluorescence RNase A capped CuInS2 quantum dots for in vivo imaging

RSC Advances ◽  
2017 ◽  
Vol 7 (80) ◽  
pp. 50949-50954 ◽  
Author(s):  
Yue Xi ◽  
Jianjun Yang ◽  
Yunshen Ge ◽  
Shenli Zhao ◽  
Jianguang Wang ◽  
...  
Keyword(s):  
Quantum Dots ◽  
Near Infrared ◽  
Rnase A ◽  
Water Soluble ◽  
One Pot ◽  
Guided Surgery ◽  
Nir Fluorescence ◽  
Fluorescence Guided Surgery ◽  
Cuins2 Quantum Dots

Near-infrared (NIR) quantum dots (QDs) have been treated as a promising candidate of imaging agents for NIR fluorescence-guided surgery. Here, the RNase A-CuInS2 QDs is good candidate, which performers well in gastrointestinal system imaging.

scholarly journals Validation of a Three-Dimensional Head and Neck Spheroid Model to Evaluate Cameras for NIR Fluorescence-Guided Cancer Surgery

2021 ◽  
Vol 22 (4) ◽  
pp. 1966
Author(s):  
Claire Egloff-Juras ◽  
Ilya Yakavets ◽  
Victoria Scherrer ◽  
Aurélie Francois ◽  
Lina Bezdetnaya ◽  
...  
Keyword(s):  
Head And Neck ◽  
Near Infrared ◽  
Tumor Model ◽  
Resection Margins ◽  
Fluorescence Signal ◽  
Multicellular Tumor Spheroid ◽  
Guided Surgery ◽  
Nir Fluorescence ◽  
Fluorescence Guided Surgery

Near-infrared (NIR) fluorescence-guided surgery is an innovative technique for the real-time visualization of resection margins. The aim of this study was to develop a head and neck multicellular tumor spheroid model and to explore the possibilities offered by it for the evaluation of cameras for NIR fluorescence-guided surgery protocols. FaDu spheroids were incubated with indocyanine green (ICG) and then included in a tissue-like phantom. To assess the capability of Fluobeam® NIR camera to detect ICG in tissues, FaDu spheroids exposed to ICG were embedded in 2, 5 or 8 mm of tissue-like phantom. The fluorescence signal was significantly higher between 2, 5 and 8 mm of depth for spheroids treated with more than 5 µg/mL ICG (p < 0.05). The fluorescence intensity positively correlated with the size of spheroids (p < 0.01), while the correlation with depth in the tissue-like phantom was strongly negative (p < 0.001). This multicellular spheroid model embedded in a tissue-like phantom seems to be a simple and reproducible in vitro tumor model, allowing a comparison of NIR cameras. The ideal configuration seems to be 450 μm FaDu spheroids incubated for 24 hours with 0.05 mg/ml of ICG, ensuring the best stability, toxicity, incorporation and signal intensity.

scholarly journals Near-Infrared Imaging With Indocyanine Green for the Treatment of Endometriosis: Results From the Gre-Endo Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Luigi Carlo Turco ◽  
Giuseppe Vizzielli ◽  
Virginia Vargiu ◽  
Salvatore Gueli Alletti ◽  
Maria De Ninno ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Infrared Imaging ◽  
False Negative ◽  
Diagnostic Value ◽  
Guided Surgery ◽  
Radiation Imaging ◽  
Fluorescence Guided Surgery ◽  
Occult Lesion ◽  
Endometriosis Surgery

IntroductionA current challenge for endometriosis surgery is to correctly identify the localizations of disease, especially when small or hidden (occult endometriosis), and to exactly define their real extension. The use of near-infrared radiation imaging (NIR) after injection of indocyanine green (ICG) represents one of the most encouraging method. The aim of this study is to assess the diagnostic value of NIR-ICG imaging in the surgical treatment of endometriosis compared with the standard of treatment.Material and MethodsThe Gre-Endo trial is a prospective, single-arm study (NCT03332004). After exploring the operatory field using the white light (WL) mode, patients were injected with ICG and then observed in NIR mode. All suspected areas were classified and chronicled according to lesions visualized only in WL, NIR-ICG, or in the combination of both. Lesion not visualized in WL was considered as suspect occult lesion (s-OcL). In addition, a random control biopsy from an apparent negative peritoneum visualized in WL and NIR-ICG imaging was taken for all patients (control cases). All lesions removed were considered “suspect endometriosis” until pathology.ResultsFifty-one patients were enrolled between January 2016 and October 2019. A total of 240 suspected lesions have been identified with both methods (WL + NIR-ICG). Two hundred and seven (86.2%) lesions out of the overall 240 were visualized with WL imaging, and 200 were confirmed to be pathologic (true positive for WL). The remaining 33/240 (13.75%) (false negative for WL) lesions were identified only with NIR-ICG imaging and collected as s-OcL. All 33 s-OcLs removed were confirmed to be pathologic (c-OcL = 100%). NIR-ICG vision showed PPV of 98.5%, NPV of 87.1%, Se of 87%, and Sp of 98.5%, confirming that this kind of imaging is an excellent diagnostic and screening test (p = 0.001 and p = 0.835, according to McNemar’s and Cohen’s kappa tests, respectively).ConclusionsThe use of NIR-ICG vision alone and combined with WL showed good results in intraoperative detection rate and fluorescence-guided surgery of endometriosis. Furthermore, NIR-ICG allowed surgeons to remove occult lesions that otherwise would remain, leading to possible greater postoperative pain and a higher risk of persistence and relapse.

scholarly journals Application of Fluorescence-Guided Surgery to Subsurface Cancers Requiring Wide Local Excision

2018 ◽  
Vol 25 (1) ◽  
pp. 107327481775233 ◽  
Author(s):  
Kimberley S. Samkoe ◽  
Brent D. Bates ◽  
Jonathan T. Elliott ◽  
Ethan LaRochelle ◽  
Jason R. Gunn ◽  
...  
Keyword(s):  
Local Excision ◽  
Wide Local Excision ◽  
Normal Tissue ◽  
Near Infrared ◽  
Growth Factor Receptor ◽  
Positive Margin ◽  
Guided Surgery ◽  
Tumor Visualization ◽  
Fluorescence Guided Surgery ◽  
Novel Concept

The excision of tumors by wide local excision is challenging because the mass must be removed entirely without ever viewing it directly. Positive margin rates in sarcoma resection remain in the range of 20% to 35% and are associated with increased recurrence and decreased survival. Fluorescence-guided surgery (FGS) may improve surgical accuracy and has been utilized in other surgical specialties. ABY-029, an anti-epidermal growth factor receptor Affibody molecule covalently bound to the near-infrared fluorophore IRDye 800CW, is an excellent candidate for future FGS applications in sarcoma resection; however, conventional methods with direct surface tumor visualization are not immediately applicable. A novel technique involving imaging through a margin of normal tissue is needed. We review the past and present applications of FGS and present a novel concept of indirect FGS for visualizing tumor through a margin of normal tissue and aiding in excising the entire lesion as a single, complete mass with tumor-free margins.

Unexpected Binding of Tozuleristide “Tumor Paint” to Cerebral Vascular Malformations: A Potentially Novel Application of Fluorescence-Guided Surgery

Neurosurgery ◽  
2021 ◽  
Author(s):  
Andrew J Kobets ◽  
David Nauen ◽  
Amy Lee ◽  
Alan R Cohen
Keyword(s):  
Near Infrared ◽  
Vascular Malformations ◽  
Cns Tumors ◽  
Matrix Metalloproteinase 2 ◽  
Cerebrovascular Lesions ◽  
Cavernous Malformations ◽  
Guided Surgery ◽  
Fluorescence Guided Surgery ◽  
Cerebral Vascular Malformations ◽  
Cerebral Vascular

Abstract BACKGROUND Fluorescence-guided surgery (FGS) is under investigation as a means to improve the extent of resection for primary central nervous system (CNS) tumors. Tozuleristide, known also as “Tumor Paint,” is an investigational tumor-targeting agent covalently conjugated to a derivative of the fluorescent dye indocyanine green. OBJECTIVE To report the finding of avid intraoperative fluorescence of tozuleristide on cerebral vascular malformations. METHODS Our institution is participating in a phase 2/3 study of intraoperative near-infrared fluorescence detection of pediatric primary CNS tumors in patients receiving intravenous tozuleristide and imaged with the Canvas system. Our site enrolled 2 patients with intracranial lesions, suspected preoperatively of possibly being gliomas that proved to be cavernous vascular malformations after resection. RESULTS Each lesion had a dark blue mulberry appearance and each fluoresced avidly with tozuleristide. Each was completely resected, and the patients recovered without deficit. Pathological assessment showed cavernous angioma for both cases. Tozuleristide fluorescence is postulated to result from binding to matrix metalloproteinase-2 and annexin A2, and literature review demonstrates expression of both these ligands on multiple cerebrovascular lesions, including cavernous malformations. CONCLUSION This finding deserves further investigation to determine if tozuleristide “Tumor Paint” may have a wider role in the identification of non-neoplastic intracranial pathologies.

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