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Efficacy of Near-Infrared Fluorescence Video-Assisted Thoracoscopic Surgery for Small Pulmonary Nodule Resection with Indocyanine Green Inhalation: A Randomized Clinical Trial

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

Abstract

Background

Small pulmonary nodules (<3 cm) can sometimes be unrecognizable and nonpalpable in video-assisted thoracoscopic surgery (VATS). Near-infrared fluorescence (NIF) VATS after indocyanine green (ICG) inhalation may effectively guide surgeons to locate the nodules.

Objective

This study aimed to investigate the safety, feasibility, and efficacy of ICG inhalation-based NIF imaging for guiding small pulmonary nodule resections.

Methods

Between February and May 2021, the first-stage, non-randomized trial enrolled 21 patients with different nodule depth, ICG inhalation doses, post-inhalation surgery times, and nodule types at a tertiary referral hospital. Between May 2021 and May 2022, the second-stage randomized trial enrolled 56 patients, who were randomly assigned to the fluorescence VATS (FLVATS) or the white-light VATS (WLVATS) group. The ratio of effective guidance and the time consumption for nodule localization were compared.

Results

The first-stage trial proved this new method is safe and feasible, and established a standardized protocol with optimized nodule depth (≤1 cm), ICG dose (0.20–0.25 mg/kg), and surgery window (50–90 min after ICG inhalation). In the second-stage trial, the FLVATS achieved 87.1% helpful nodule localization guidance, which was significantly higher than the WLVATS (59.1%, p < 0.05). The mean nodule locating time (standard deviation) was 1.8 [0.9] and 3.3 [2.3] min, respectively. Surgeons adopting FLVATS were significantly faster (p < 0.01), especially when locating small ground-glass opacities (1.3 [0.6] min vs. 7.0 [3.5] min, p < 0.05). Five of 31 nodules (16.1%) were only detectable by FLVATS, whereas both white light and palpation failed.

Conclusions

This new method is safe and feasible for small pulmonary nodule resection. It significantly improves nodule localization rates with less time consumption, and hence is highly worthy for clinical promotion.

Clinical Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2100047326

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Funding

This work was supported by the Ministry of Science and Technology of China under grant no. 2017YFA0205200; the National Natural Science Foundation of China under grant nos. 62027901, 81227901, 81930053, and 92159305; and the Excellent Member Project of Youth Innovation Promotion Association CAS (membership 2016124), and was supported by Hainan Province Clinical Medical Center.

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Author notes

  1. Kun Wang, Weiyuan Huang, and Xianshan Chen contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China

    Kun Wang PhD, Weiyuan Huang MD, Jiali Song BM, Qianyu Yang BM, Jie Tian PhD & Feng Chen MD

  2. CAS Key Laboratory and Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China

    Kun Wang PhD, Xin Feng PhD & Chongwei Chi PhD

  3. Department of Thoracic Surgery, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan Province, China

    Xianshan Chen MM, Gao Li MM, Xiuming Huang MM, Xuqiang Liao MM & Fengxia Chen MD

  4. Department of Anesthesiology, Hainan General Hospital (Affiliated Hainan Hospital of Hainan Medical University), Haikou, Hainan, China

    Na Li MM

  5. Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China

    Kunshan He PhD, Yu An PhD, Zeyu Zhang PhD & Jie Tian PhD

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Contributions

JT, FXC, and FC had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: KW, WYH, JT, FXC, FC. Acquisition, analysis, or interpretation data: KW, WYH, XSC, GL, NL, XMH, XQL, JLS, QYY, KSH, FC. Drafting of the manuscript: KW, WYH. Critical revision of the manuscript for important intellectual content: KW, WYH. Statistical analysis: KW, WYH. Obtained funding: KW, JT. Administrative, technical, or material support: KW, WYH, KSH, FXC, FC. Supervision: JT, FXC, FC.

Corresponding authors

Correspondence to Jie Tian PhD, Fengxia Chen MD or Feng Chen MD.

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Kun Wang, Weiyuan Huang, Xianshan Chen, Gao Li, Na Li, Xiuming Huang, Xuqiang Liao, Jiali Song, Qianyu Yang, Kunshan He, Yu An, Xin Feng, Zeyu Zhang, Chongwei Chi, Jie Tian, Fengxia Chen, and Feng Chen declare no conflicts of interest.

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Wang, K., Huang, W., Chen, X. et al. Efficacy of Near-Infrared Fluorescence Video-Assisted Thoracoscopic Surgery for Small Pulmonary Nodule Resection with Indocyanine Green Inhalation: A Randomized Clinical Trial. Ann Surg Oncol 30, 5912–5922 (2023). https://doi.org/10.1245/s10434-023-13753-4

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