Improved visualization of virtual-assisted lung mapping by indocyanine green

Area of Science:

• Pulmonology
• Surgical Oncology
• Medical Imaging

Background:

• Virtual-assisted lung mapping (VAL-MAP) is a bronchoscopic technique for marking nonpalpable lung nodules prior to resection.
• Challenges exist in visualizing traditional VAL-MAP markings on CT scans and during thoracoscopy.
• Indocyanine green (ICG) offers potential for improved visualization in bronchoscopic procedures.

Purpose of the Study:

• To develop and assess the feasibility of indocyanine green VAL-MAP (ICG-VAL-MAP) for enhanced marking visualization.
• To compare the marking visibility of ICG-VAL-MAP against conventional VAL-MAP.
• To evaluate the safety and efficacy of ICG-VAL-MAP in a historical control trial.

Main Methods:

• A historical control trial compared ICG-VAL-MAP with VAL-MAP.
• ICG-VAL-MAP utilized indocyanine green and CT contrast agents for marking, visualized with near-infrared fluorescence endoscopy.
• Marking visibility was graded (easy, faint, not identifiable) and compared on CT images and during thoracoscopy.

Main Results:

• ICG-VAL-MAP demonstrated significantly superior marking visualization on preoperative CT scans compared to VAL-MAP (100% easy/faint vs. 75%).
• Intraoperative marking visibility was also significantly better with ICG-VAL-MAP (99.3% easy/faint vs. 85.5%).
• Complication rates, including pneumothorax and fever, were comparable or lower with ICG-VAL-MAP.

Conclusions:

• ICG-VAL-MAP offers significantly improved visibility of lung markings compared to standard VAL-MAP.
• The enhanced visualization may aid in the precise resection of nonpalpable small lung lesions.
• ICG-VAL-MAP presents a feasible and potentially safer alternative for lung nodule marking.