Related Experiment Video
Updated: Aug 20, 2025
Fluorescent Laparoscopic Central Hepatectomy for Liver Cancer Using Indocyanine Green Negative Staining
Published on: March 17, 2023
Indocyanine green fluorescence patterns of hepatocellular carcinoma correlate with pathological and molecular
Mylène Sebagh1, Christophe Desterke2, Cyrille Feray3
1AP-HP Hôpital Paul-Brousse, Laboratoire d'Anatomopathologie, Villejuif, F-94800, France; UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France; Université Paris-Saclay, Villejuif, F-94800, France.
Background:
Intraoperative Indocyanine Green Dye (ICG) routinely used in hepatobiliary surgery identifies different fluorescent patterns of hepatocellular carcinoma (HCC), a highly heterogeneous cancer. We aimed to correlate these patterns with gene mutations and extensive pathological features beyond the well-known tumor differentiation.
Methods:
Between February 2017 and December 2019, 21 HCC in 16 consecutive patients who underwent intraoperative ICG fluorescence imaging were included. Pathological review was performed by one pathologist blinded to fluorescence features. Random forest machine learning algorithm correlated pathological features of the tumor, peritumoral and non-tumoral liver, and gene mutations from a 28 gene-panel with rim and intra-lesion fluorescence.
Results:
Three HCC had negative intra-lesion and rim-like emission, 7 HCC had homogeneous pattern and 11 heterogeneous patterns in whom 3 with rim-like emission. Rim emission was associated with peritumoral vascular changes, lower differentiation and lower serum AFP level. Homogeneous intra-lesion fluorescence was associated with lower necrosis rate, thinner capsule, absence of peritumoral liver changes, and higher serum AFP level. Heterogeneous HCC without rim harbored lesser TP53 and ARID1A mutations.
Conclusion:
Tumoral and peri-tumoral fluorescence classification of HCC yielded a possible intraoperative pathological and molecular characterization. These preliminary observations could lead to intraoperative refinement in surgical strategy.
