Eva Lieto1, Annamaria Auricchio1, Francesca Cardella1, Andrea Mabilia1, Nicoletta Basile1, Paolo Castellano1, Michele Orditura2, Gennaro Galizia3. 1. Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli' - School of Medicine, c/o II Policlinico, Edificio 17, Via Pansini, 5, 80131, Naples, Italy. 2. Division of Medical Oncology - "F. Magrassi" Department of Clinical and Experimental Medicine, University of Campania 'Luigi Vanvitelli' - School of Medicine, Naples, Italy. 3. Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli' - School of Medicine, c/o II Policlinico, Edificio 17, Via Pansini, 5, 80131, Naples, Italy. gennaro.galizia@unicampania.it.
Abstract
BACKGROUND: Indocyanine green (ICG) is a near-infrared fluorescent contrast agent, which preferentially accumulates in cancer tissue. The aim of our study was to investigate the role of fluorescence imaging (FI) with ICG (ICG-FI) for detecting peritoneal carcinomatosis (PC) from colorectal cancer (CRC). METHODS: Four CRC patients with PC scheduled for cytoreductive surgery + hyperthermic intraperitoneal chemotherapy were enrolled in this prospective study. At a median time of 50 min after 0.25 mg/kg ICG injected intravenously, intraoperative ICG-FI using Fluobeam® was performed in vivo and ex vivo on all specimens. The Peritoneal Cancer Index was used to estimate the likelihood of complete cytoreduction. RESULTS: No severe complications were recorded. ICG-FI took a median of 20 min (range 10-30, IQR 15-25). Sixty-nine nodules were harvested. Fifty-two nodules had been diagnosed preoperatively by conventional imaging (n = 30; 43%) or intraoperatively by visual inspection/palpation (n = 22; 32%). With ICG-FI, 47 (90%) nodules were hyperfluorescent, and five hypofluorescent. Intraoperative ICG-FI identified 17 additional hyperfluorescent nodules. On histopathology, 16 were metastatic nodules. Sensitivity increased from 76.9%, with the conventional diagnostic procedures, to 96.9% with ICG-FI. The positive predictive value of ICG-FI was 98.4%, and test accuracy was 95.6%. Diagnostic performance of ICG-FI was significantly better than preoperative (p = 0.027) and intraoperative conventional procedures (p = 0.042). The median PCI score increased from 7 to 10 after ICG-FI (p < 0.001). CONCLUSIONS: Our results suggest that intraoperative ICG-FI can improve outcomes in patients undergoing CS for PC from CRC. Further studies are needed to determine the role of ICG-FI in this patient population.
BACKGROUND:Indocyanine green (ICG) is a near-infrared fluorescent contrast agent, which preferentially accumulates in cancer tissue. The aim of our study was to investigate the role of fluorescence imaging (FI) with ICG (ICG-FI) for detecting peritoneal carcinomatosis (PC) from colorectal cancer (CRC). METHODS: Four CRC patients with PC scheduled for cytoreductive surgery + hyperthermic intraperitoneal chemotherapy were enrolled in this prospective study. At a median time of 50 min after 0.25 mg/kg ICG injected intravenously, intraoperative ICG-FI using Fluobeam® was performed in vivo and ex vivo on all specimens. The Peritoneal Cancer Index was used to estimate the likelihood of complete cytoreduction. RESULTS: No severe complications were recorded. ICG-FI took a median of 20 min (range 10-30, IQR 15-25). Sixty-nine nodules were harvested. Fifty-two nodules had been diagnosed preoperatively by conventional imaging (n = 30; 43%) or intraoperatively by visual inspection/palpation (n = 22; 32%). With ICG-FI, 47 (90%) nodules were hyperfluorescent, and five hypofluorescent. Intraoperative ICG-FI identified 17 additional hyperfluorescent nodules. On histopathology, 16 were metastatic nodules. Sensitivity increased from 76.9%, with the conventional diagnostic procedures, to 96.9% with ICG-FI. The positive predictive value of ICG-FI was 98.4%, and test accuracy was 95.6%. Diagnostic performance of ICG-FI was significantly better than preoperative (p = 0.027) and intraoperative conventional procedures (p = 0.042). The median PCI score increased from 7 to 10 after ICG-FI (p < 0.001). CONCLUSIONS: Our results suggest that intraoperative ICG-FI can improve outcomes in patients undergoing CS for PC from CRC. Further studies are needed to determine the role of ICG-FI in this patient population.
Authors: Sungjee Kim; Yong Taik Lim; Edward G Soltesz; Alec M De Grand; Jaihyoung Lee; Akira Nakayama; J Anthony Parker; Tomislav Mihaljevic; Rita G Laurence; Delphine M Dor; Lawrence H Cohn; Moungi G Bawendi; John V Frangioni Journal: Nat Biotechnol Date: 2003-12-07 Impact factor: 54.908
Authors: Aaron U Blackham; Gregory B Russell; John H Stewart; Konstantinos Votanopoulos; Edward A Levine; Perry Shen Journal: Ann Surg Oncol Date: 2014-03-11 Impact factor: 5.344
Authors: Jacques Ferlay; Isabelle Soerjomataram; Rajesh Dikshit; Sultan Eser; Colin Mathers; Marise Rebelo; Donald Maxwell Parkin; David Forman; Freddie Bray Journal: Int J Cancer Date: 2014-10-09 Impact factor: 7.396
Authors: Ahmed Refaat; May Lin Yap; Geoffrey Pietersz; Xiaowei Wang; Karlheinz Peter; Aidan Patrick Garing Walsh; Johannes Zeller; Blanca Del Rosal Journal: J Nanobiotechnology Date: 2022-10-15 Impact factor: 9.429
Authors: Thinzar M Lwin; Michael A Turner; Siamak Amirfakhri; Hiroto Nishino; Robert M Hoffman; Michael Bouvet Journal: Cells Date: 2022-01-12 Impact factor: 6.600
Authors: Gijsbert M Kalisvaart; Ruben P J Meijer; Okker D Bijlstra; Hidde A Galema; Wobbe O de Steur; Henk H Hartgrink; Cornelis Verhoef; Lioe-Fee de Geus-Oei; Dirk J Grünhagen; Yvonne M Schrage; Alexander L Vahrmeijer; Jos A van der Hage Journal: Cancers (Basel) Date: 2022-03-18 Impact factor: 6.639