Near-infrared (NIR) imaging with indocyanine green (ICG) may assist in intraoperative decision making and improving surgical margin in bone and soft tissue tumor surgery
Huayi Huang, Siyuan He, and Renxiong Wei contributed equally to this work and shared first authorship.
Abstract
Background and Objectives
Negative surgical margins are significant in improving patient outcomes. However, surgeons can only rely on visual and tactile information to identify tumor margins intraoperatively. We hypothesized that intraoperative fluorescence imaging with indocyanine green (ICG) could serve as an assistive technology to evaluate surgical margins and guide surgery in bone and soft tissue tumor surgery.
Methods
Seventy patients with bone and soft tissue tumors were enrolled in this prospective, non-randomized, single-arm feasibility study. All patients received intravenous indocyanine green (0.5 mg/kg) before surgery. Near-infrared (NIR) imaging was performed on in situ tumors, wounds, and ex vivo specimens.
Results
60/70 tumors were fluorescent at NIR imaging. The final surgical margins were positive in 2/55 cases, including 1/40 of the sarcomas. Surgical decisions were changed in 19 cases by NIR imaging, and in 7/19 cases final pathology demonstrated margins were improved. Fluorescence analysis showed that the tumor-to-background ratio (TBR) of primary malignant tumors was higher than that of benign, borderline, metastatic, and tumors ≥5 cm in size had higher TBR than those <5 cm.
Conclusions
ICG fluorescence imaging may be a beneficial technique to assist in surgical decision making and improving surgical margins in bone and soft tissue tumor surgery.
CONFLICTS OF INTEREST STATEMENT
All authors had financial support from the Improvement Project for Theranostic Ability on Difficulty Miscellaneous Disease (Tumor) (ZLYNXM202005), and the Research Fund from Medical Sci-Tech Innovation Platform of Zhongnan Hospital, Wuhan University (PTXM2021003), and Key R&D plan of Hubei Province (2022BCA032) for the submitted work; these funding sources had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to submit results; no financial relationships with any organizations that might have an interest in the submitted work in the previous 5 years; and no other relationships or activities that could appear to have influenced the submitted work.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
