Indocyanine green cannot predict malignancy in partial nephrectomy: histopathologic correlation with fluorescence...

Area of Science:

• Urology
• Surgical Oncology
• Medical Imaging

Background:

• Indocyanine green (ICG) is increasingly used in robot-assisted partial nephrectomy (RAPN) to visualize renal vasculature, masses, and margins.
• The relationship between renal mass histology and ICG fluorescence patterns requires further investigation.

Purpose of the Study:

• To describe ICG fluorescence patterns in 100 RAPN cases.
• To correlate ICG fluorescence patterns with renal mass histology and malignancy.

Main Methods:

• Prospective review of a RAPN database.
• Categorization of ICG fluorescence patterns: isofluorescent, hypofluorescent, or afluorescent.
• Descriptive statistics to analyze fluorescence patterns and histology.

Main Results:

• Afluorescent patterns were observed in all 14 cystic lesions (9 malignant, 5 benign).
• Hypofluorescent patterns were most common in solid lesions (83/86), including 65 malignant and 18 benign tumors.
• Hypofluorescence showed a positive predictive value of 87% for malignancy but limited specificity (57%).

Conclusions:

• A three-grade classification of renal mass ICG fluorescence correlates with some histologic findings.
• ICG fluorescence patterns alone are insufficient to reliably predict malignancy in renal masses during RAPN.