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Fluorescence Imaging-Guided Identification of Thymic Masses Using Low-Dose Indocyanine Green

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 18 March 2022

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Abstract

Background

Indocyanine green (ICG) fluorescence imaging has been used to detect many types of tumors during surgery; however, there are few studies on thymic masses and the dose and time of ICG injection have not been optimized.

Objective

We aimed to evaluate the optimal ICG injection dose and timing for detecting thymic masses during surgery.

Method

Forty-nine consecutive patients diagnosed with thymic masses on preoperative computed tomography (CT) and scheduled to undergo thymic cystectomy or thymectomy were included. Patients were administered 1, 2, or 5 mg/kg of ICG at different times. Thymic masses were observed during and after surgery using a near-infrared fluorescence imaging system, and the fluorescence signal tumor-to-normal ratio (TNR) was analyzed.

Results

Among the 49 patients, 14 patients with thymic cysts showed negative fluorescence signals, 33 patients with thymoma or thymic carcinoma showed positive fluorescence signals, and 2 patients showed insufficient fluorescence signals. The diagnosis of thymic masses based on CT was correct in 32 (65%) of 49 cases; however, the differential diagnosis of thymic masses based on NIR signals was correct in 47 of 49 cases (96%), including 14 cases of thymic cysts (100%) and 33 cases of thymomas or thymic carcinomas (94%). In addition, TNR was not affected by the time or dose of ICG injection, histological type, stage, or tumor size.

Conclusions

Low-dose intravenous injection of ICG at flexible time can detect thymic tumors. In addition, thymic cysts can be distinguished from thymomas or thymic carcinomas during surgery by the absence of ICG fluorescence signals.

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Funding

This work was supported by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (No: HI19C0166).

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Authors and Affiliations

  1. Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea

    Yu Hua Quan PhD, Byeong Hyeon Choi PhD, Jiyun Rho MS & Hyun Koo Kim MD, PhD

  2. Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital College of Medicine, Korea University, Seoul, Republic of Korea

    Yu Hua Quan PhD, Rong Xu MS, Byeong Hyeon Choi PhD, Jiyun Rho MS, Jun Hee Lee MD, Kook Nam Han MD, Young Ho Choi MD, PhD & Hyun Koo Kim MD, PhD

  3. Department of Bio-Convergence, Korea University, Seoul, Republic of Korea

    Beop-Min Kim PhD

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  1. Yu Hua Quan PhD
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YHQ, RX, BHC, JR, JHL, KNH, YHC, B-MK, and HKK declare that they have no competing interests.

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Supplementary Information

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Intraoperative differentiation of thymic cyst from thymoma based on the NIR fluorescence signal. (MP4 24546 kb)

10434_2022_11466_MOESM2_ESM.jpg

Comparison of TNR in simple cysts, multilocular cysts, and sticky fluid density cysts. Error bars represent the SD value of TNR (**P < 0.001). TNR, tumor-to-normal ratio; CT, computed tomography; SD, standard deviation. (JPG 147 kb)

Supplementary file3 (DOCX 13 kb)

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Quan, Y.H., Xu, R., Choi, B.H. et al. Fluorescence Imaging-Guided Identification of Thymic Masses Using Low-Dose Indocyanine Green. Ann Surg Oncol 29, 4476–4485 (2022). https://doi.org/10.1245/s10434-022-11466-8

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