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Detection of hepatocellular carcinomas with near-infrared fluorescence imaging using indocyanine green: its usefulness and limitation

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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

Indocyanine green (ICG), an agent for measuring liver function, becomes fluorescent under near-infrared (NIR) light after binding to serum proteins. Hepatocellular carcinoma (HCC) with a deposit of preoperatively administered ICG becomes clearly detectable under ICG fluorography; however, it remains unclear whether this detection method is always reliable. This case series study was designed to clarify the reliability of this method.

Methods

ICG (0.5 mg/kg) was injected from the 3rd to 28th preoperative day to evaluate hepatic function in 58 patients with HCCs. Preoperative imaging modalities identified 76 HCC foci. The operative fields and resected specimens were observed with an NIR camera system. Preoperatively detected lesions and lesions newly detected by the ICG fluorography were histologically investigated.

Results

ICG fluorography identified 73 of 76 preoperatively diagnosed HCC lesions. Intraoperative ICG fluorography visualized 47 lesions in 40 patients. The other 26 lesions showing emission were found in the sectioned specimens under NIR observation. Other than preoperatively diagnosed foci, ICG fluorography visualized 35 new lesions, including 6 HCCs, 2 dysplastic nodules and 27 non-neoplastic lesions, such as bile plugs and cysts. The sensitivity of ICG fluorography for HCCs was 96% and its positive predictive value was 71.5%.

Conclusions

Indocyanine green fluorography is useful to detect HCCs; however, attention should be paid to the fact that HCCs may be occasionally overlooked by this imaging method and that lesions detected by this method are not always neoplastic lesions.

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Abbreviations

CT:

Computed tomography

CTHA:

CT during hepatic arteriography

FFPE:

Formalin fixed and paraffin embedded

HCC:

Hepatocellular carcinomas

ICG:

Indocyanine green

MDR3:

Multidrug resistance P-glycoprotein 3

MRI:

Magnetic resonance imaging

NIR:

Near-infrared

NTCP:

Na+-taurocholate co-transporting polypeptide

OATP:

Organ anion transporting polypeptide

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Acknowledgments

We would like to thank Tomoyuki Kato for expert technical assistance.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan

    Yoshifumi Morita, Takanori Sakaguchi, Naoki Unno, Yasushi Shibasaki, Atsushi Suzuki, Kazuhiko Fukumoto, Keisuke Inaba & Hiroyuki Konno

  2. Department of Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Satoshi Baba

  3. Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Yasuo Takehara

  4. Department of Surgery, Iwata City Hospital, Iwata, Japan

    Shohachi Suzuki

Authors
  1. Yoshifumi Morita
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  2. Takanori Sakaguchi
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  3. Naoki Unno
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  4. Yasushi Shibasaki
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  5. Atsushi Suzuki
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  6. Kazuhiko Fukumoto
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  7. Keisuke Inaba
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  8. Satoshi Baba
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  9. Yasuo Takehara
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  10. Shohachi Suzuki
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  11. Hiroyuki Konno
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Corresponding author

Correspondence to Yoshifumi Morita.

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Morita, Y., Sakaguchi, T., Unno, N. et al. Detection of hepatocellular carcinomas with near-infrared fluorescence imaging using indocyanine green: its usefulness and limitation. Int J Clin Oncol 18, 232–241 (2013). https://doi.org/10.1007/s10147-011-0367-3

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  • DOI: https://doi.org/10.1007/s10147-011-0367-3

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