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Intraoperative Near-infrared Fluorescence (NIR) Imaging With Indocyanine Green (ICG) Can Identify Bone and Soft
Fabio Nicoli1,2,3, Daniel B Saleh1, Bence Baljer1,2
1Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary Hospital Newcastle NHS Foundation Trust, Newcastle upon Tyne, UK.
Background:
Complete excision of sarcomas to maximize function without compromising the oncological outcome can be challenging. The aim of this study was to investigate the feasibility and potential drawbacks of near-infrared (NIR) fluorescence imaging with indocyanine green during resection of bone and soft tissue sarcomas.
Methods:
Eleven patients with high-grade sarcomas were enrolled in the study. All patients received intravenous indocyanine green (75 mg) between 16 and 24 hours before the resection. Sarcomas were resected under NIR guidance and specimens were sent for routine histopathological analysis.
Results:
Majority of treatment naive tumors demonstrated fluorescence. There were no adverse events from the indocyanine green administration. In 3 cases, the fluorescence was reported by the surgeon to have been of definite guidance leading to further tissue resection to improve the margin.
Conclusion:
This is the first report of NIR fluorescence guidance in the setting of open sarcoma surgery. The technique is acceptable to patients and surgeons and was able to guide resection. Multicenter studies are required to assess the utility of this technique in a large cohort of patients with regards to quantification of fluorescence, resection guidance, and longer follow-up period.
Insights
Near-infrared fluorescence imaging using indocyanine green aided sarcoma resection in 11 patients. This technique guided surgeons in achieving better margins for bone and soft tissue sarcomas without adverse events.
Area of Science:
- Oncology
- Surgical Innovation
- Medical Imaging
Background:
- Complete excision of sarcomas is challenging, balancing functional preservation with oncological outcomes.
- Near-infrared (NIR) fluorescence imaging offers a potential solution for enhanced visualization during surgery.
Purpose of the Study:
- To evaluate the feasibility and potential drawbacks of NIR fluorescence imaging with indocyanine green (ICG) in sarcoma resection.
- To assess the utility of ICG-guided surgery for bone and soft tissue sarcomas.
Main Methods:
- Eleven patients with high-grade sarcomas underwent ICG administration (75 mg IV) 16-24 hours pre-operatively.
- Sarcoma resection was performed using NIR fluorescence guidance.
- Specimens were analyzed via histopathology.
Main Results:
- Most treatment-naive tumors exhibited fluorescence.
- No adverse events were reported following ICG administration.
- Surgeons reported definite guidance from fluorescence in 3 cases, leading to additional resection for improved margins.
Conclusions:
- This study is the first to report NIR fluorescence guidance in open sarcoma surgery.
- The technique is well-tolerated by patients and surgeons and demonstrated utility in guiding resection.
- Multicenter trials are needed to validate these findings in larger patient cohorts and assess long-term outcomes.
