Masaki Kaibori1, Kosuke Matsui2, Morihiko Ishizaki2, Hiroya Iida2, Tadayoshi Okumura2, Tatsuma Sakaguchi2, Kentaro Inoue2, Tsukasa Ikeura3, Hiroaki Asano4, Masanori Kon2. 1. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan kaibori@hirakata.kmu.ac.jp. 2. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. 3. Third Department of Internal Medicine, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan. 4. School of Nursing, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Abstract
BACKGROUND/AIM: Indocyanine green (ICG) and the porphyrin precursor 5-aminolevulinic acid (5-ALA) have been approved as fluorescence imaging agents in the clinical setting. This study evaluated the usefulness of fluorescence imaging with both ICG and 5-ALA for intraoperative identification of latent small liver tumors. PATIENTS AND METHODS: There were 48 patients who had main tumors within 5 mm of the liver surface. 5-ALA hydrochloride was orally administered to patients 3 h before surgery. ICG had been intravenously injected within 14 days prior to surgery. Intraoperatively, after visual inspection, manual palpation and ultrasonography fluorescence images of the liver surface were obtained with ICG and 5-ALA prior to resection. RESULTS: With ICG, the sensitivity, specificity and accuracy for detecting the preoperatively identified main tumors were 96%, 50% and 94%, respectively. Twelve latent small tumors were newly detected on the liver surface using ICG, five of which proved to be carcinomas. With 5-ALA, the sensitivity, specificity and accuracy for detecting the main tumors were 57%, 100% and 58%, respectively. Five latent small tumors were newly detected using 5-ALA; all were carcinomas. Overall, five new tumors were detected by both ICG and 5-ALA fluorescence imaging; two were hepatocellular carcinomas (HCCs) and three were metastases of colorectal cancer. The sensitivity and specificity of ICG fluorescence imaging for main tumor detection were relatively high and low, respectively, but the opposite was true of 5-ALA imaging. CONCLUSION: Fluorescence imaging using 5-ALA may provide greater specificity in the detection of surface-invisible malignant liver tumors than using ICG fluorescence imaging alone. Copyright
BACKGROUND/AIM: Indocyanine green (ICG) and the porphyrin precursor 5-aminolevulinic acid (5-ALA) have been approved as fluorescence imaging agents in the clinical setting. This study evaluated the usefulness of fluorescence imaging with both ICG and 5-ALA for intraoperative identification of latent small liver tumors. PATIENTS AND METHODS: There were 48 patients who had main tumors within 5 mm of the liver surface. 5-ALA hydrochloride was orally administered to patients 3 h before surgery. ICG had been intravenously injected within 14 days prior to surgery. Intraoperatively, after visual inspection, manual palpation and ultrasonography fluorescence images of the liver surface were obtained with ICG and 5-ALA prior to resection. RESULTS: With ICG, the sensitivity, specificity and accuracy for detecting the preoperatively identified main tumors were 96%, 50% and 94%, respectively. Twelve latent small tumors were newly detected on the liver surface using ICG, five of which proved to be carcinomas. With 5-ALA, the sensitivity, specificity and accuracy for detecting the main tumors were 57%, 100% and 58%, respectively. Five latent small tumors were newly detected using 5-ALA; all were carcinomas. Overall, five new tumors were detected by both ICG and 5-ALA fluorescence imaging; two were hepatocellular carcinomas (HCCs) and three were metastases of colorectal cancer. The sensitivity and specificity of ICG fluorescence imaging for main tumor detection were relatively high and low, respectively, but the opposite was true of 5-ALA imaging. CONCLUSION: Fluorescence imaging using 5-ALA may provide greater specificity in the detection of surface-invisible malignant liver tumors than using ICG fluorescence imaging alone. Copyright
Authors: H J M Handgraaf; L S F Boogerd; D J Höppener; A Peloso; B G Sibinga Mulder; C E S Hoogstins; H H Hartgrink; C J H van de Velde; J S D Mieog; R J Swijnenburg; H Putter; M Maestri; A E Braat; J V Frangioni; A L Vahrmeijer Journal: Eur J Surg Oncol Date: 2017-05-06 Impact factor: 4.424
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