Abdelhafeez H Abdelhafeez1, Andrew J Murphy2, Rachel Brennan3, Teresa C Santiago4, Zhaohua Lu5, Matthew J Krasin6, John J Bissler7, Joseph M Gleason8, Andrew M Davidoff2. 1. Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA. Electronic address: Hafeez.Abdelhafeez@stjude.org. 2. Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA. 3. Department of Oncology, MS 260, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. 4. Department of Pathology, MS 250, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. 5. Department of Biostatistics, MS 768, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. 6. Department of Radiation Oncology, MS 210, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA. 7. Division of Pediatric Nephrology, Le Bonheur Children's Hospital and St. Jude Children's Research Hospital, Memphis, TN, USA. 8. Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Urology, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA.
Abstract
BACKGROUND: Indocyanine green (ICG), a water-soluble tricarbocyanine fluorophore, is being increasingly used for tumor localization based on its passive intra-tumoral accumulation due to enhanced permeability and retention in tumor tissue. Therefore, we hypothesized that ICG can provide contrast to facilitate accurate, real-time recognition of renal tumors at the time of nephron-sparing surgery in children. METHODS: This retrospective study examined the feasibility of ICG in guiding nephron-sparing surgery for pediatric renal tumors. RESULTS: We reviewed the medical records of 8 pediatric patients with renal tumors in 12 kidneys. Intraoperative localization of tumor with near infrared guidance was successful in all 12 kidneys. However, we consistently found an inverse pattern of near infrared signal in which the normal kidney demonstrated increased fluorescent signal relative to the kidney tumor. CONCLUSIONS: Fluorescence-guided renal tumor delineation is unique because it has an inverse pattern of near infrared signal in which the normal kidney demonstrates increased signal relative to the adjacent tumor. Nevertheless fluorescence-guided distinguishing of renal tumor from surrounding normal kidney is feasible.
BACKGROUND: Indocyanine green (ICG), a water-soluble tricarbocyanine fluorophore, is being increasingly used for tumor localization based on its passive intra-tumoral accumulation due to enhanced permeability and retention in tumor tissue. Therefore, we hypothesized that ICG can provide contrast to facilitate accurate, real-time recognition of renal tumors at the time of nephron-sparing surgery in children. METHODS: This retrospective study examined the feasibility of ICG in guiding nephron-sparing surgery for pediatric renal tumors. RESULTS: We reviewed the medical records of 8 pediatric patients with renal tumors in 12 kidneys. Intraoperative localization of tumor with near infrared guidance was successful in all 12 kidneys. However, we consistently found an inverse pattern of near infrared signal in which the normal kidney demonstrated increased fluorescent signal relative to the kidney tumor. CONCLUSIONS: Fluorescence-guided renal tumor delineation is unique because it has an inverse pattern of near infrared signal in which the normal kidney demonstrates increased signal relative to the adjacent tumor. Nevertheless fluorescence-guided distinguishing of renal tumor from surrounding normal kidney is feasible.