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Can indocyanine green fluorescence aid operative decision making in neuroblastic tumour surgery? Early experience
Max Pachl1, Hetal Patel2, G Suren Arul2
1Department of Paediatric Surgery and Urology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham Children's Hospital, Birmingham, UK; Institute of Cancer and Genomic Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK; Prinses Maxima Centrum voor Kinderoncologie, Utrecht, UK.
Introduction:
Surgery for neuroblastic tumours can entail difficult decisions about what and where to resect. Indocyanine Green(ICG) near-infrared fluorescence(NIRF) may help with decisions about resecting disease where critical structures are at risk of injury or where a total resection would cause life changing disability. We reviewed the results for all children undergoing ICG NIRF guided surgery for neuroblastic tumours in our centre.
Materials And Methods:
Review of single quaternary centre patients between 01/2019 and 12/2023 with a neuroblastic tumour undergoing surgical biopsy or resection with ICG NIRF. Demographics, imaging, tumour details, ICG dosing, intra-operative findings, pathology reports and follow up were reviewed.
Results:
Twelve patients(6F) underwent 17 surgical procedures (12 resections and 5 biopsies). Six patients were stage L1, four patients L2 and two patients had metastatic disease. Eight patients had neuroblastoma (NBL), 2 ganglioneuroma (GN), and 1 ganglioneuroblastoma (GNBL). One case had mixed biology with multiple foci of NBL and GN. Aflourescence/hypofluorescence occurred in 8 patients with GN, GNBL or <10 % viable NBL. Hyperfluorescence was seen in three patients with primitive neuroblasts confirmed on pathology. In the patient with mixed biology, ICG NIRF showed hyperfluorescent areas (containing primitive neuroblasts) and afluorescent ones (containing GN). Following chemotherapy, all disease was afluorescent. In the fluorescent NBL lesions, NIR microscopy showed a median (IQR) tumour to background ratio (TBR) of 5.385 (4.2):1.
Conclusion:
The results of this preliminary small cohort suggest that ICG NIRF can predict the presence of primitive neuroblastic tissue and be a useful adjunct to surgical decision making.
