Related Experiment Video
Updated: Jul 31, 2025
The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
Published on: January 31, 2025
Vascular permeability in HPV+ oropharyngeal cancers aids in fluorescent image-guided transoral robotic surgery using
Nitish Khurana1,2, Eric Babajanian3, Hilary McCrary3
1Department of Molecular Pharmaceutics, University of Utah, Salt Lake City, Utah, USA.
Background:
Indocyanine green (ICG) fluorescent image (FI)-guided surgery has demonstrated success in improving intraoperative visualization and tumor resections. The objectives were to evaluate the use of IGC in FI-guided transoral robotic surgery (TORS) and the underlying molecular mechanism.
Methods:
HPV+ oropharyngeal squamous cell carcinoma (OPSCCa) patient (n = 10) undergoing TORS were enrolled in this prospective study. Participants received intravenous ICG. Excised tissues were evaluated for ICG accumulation, tumor demarcation, and pathological characteristics using In-vivo imaging system (IVIS), histology, and RNA sequencing.
Results:
ICG accumulation was significantly increased in primary tumor and pathological lymph nodes compared with normal tissues (p < 0.001). IVIS was 91.3% accurate in identifying OPSCCa in excised tissues; the correlation between IVIS- and histologically determined tumor tissues was significant (R2 = 0.8301; p = 0.001). Genes associated with vascular and angiogenic signaling pathways were significantly upregulated in OPSCCa tissues.
Conclusion:
ICG effectively demarcates tumor margins in OPSCCa, due to the increased upregulation of genes associated with vascular permeability.
Insights
Indocyanine green (ICG) fluorescence imaging effectively identifies oropharyngeal squamous cell carcinoma (OPSCCa) margins during transoral robotic surgery (TORS). This is due to increased vascular permeability in tumors, aiding precise tumor resection.
Area of Science:
- Oncology
- Surgical Innovation
- Molecular Biology
Background:
- Indocyanine green (ICG) fluorescent image (FI)-guided surgery enhances intraoperative visualization and tumor resection.
- Transoral robotic surgery (TORS) is a key technique for head and neck cancers.
Purpose of the Study:
- To evaluate Indocyanine green (ICG) in FI-guided TORS for HPV+ oropharyngeal squamous cell carcinoma (OPSCCa).
- To investigate the underlying molecular mechanisms of ICG accumulation in OPSCCa.
Main Methods:
- Prospective study of 10 HPV+ OPSCCa patients undergoing TORS.
- Intravenous administration of ICG, followed by in-vivo imaging system (IVIS), histology, and RNA sequencing of excised tissues.
Main Results:
- ICG accumulation was significantly higher in primary tumors and lymph nodes versus normal tissues (p < 0.001).
- IVIS demonstrated 91.3% accuracy in identifying OPSCCa in excised tissues, with high correlation to histology (R² = 0.8301, p = 0.001).
- Genes related to vascular and angiogenic pathways were significantly upregulated in OPSCCa tissues.
Conclusions:
- ICG effectively demarcates tumor margins in OPSCCa during TORS.
- Upregulation of genes associated with vascular permeability underlies ICG's efficacy in tumor margin identification.
