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Int J Clin Oncol (2013) 18:232241 DOI 10.1007/s10147-011-0367-3
ORIGINAL ARTICLE
Detection of hepatocellular carcinomas with near-infrared uorescence imaging using indocyanine green: its usefulness and limitation
Yoshifumi Morita Takanori Sakaguchi Naoki Unno Yasushi Shibasaki
Atsushi Suzuki Kazuhiko Fukumoto Keisuke Inaba Satoshi Baba
Yasuo Takehara Shohachi Suzuki Hiroyuki Konno
Received: 5 August 2011 / Accepted: 12 December 2011 / Published online: 27 December 2011 Japan Society of Clinical Oncology 2011
AbstractBackground Indocyanine green (ICG), an agent for measuring liver function, becomes uorescent under near-infrared (NIR) light after binding to serum proteins. Hepatocellular carcinoma (HCC) with a deposit of preoperatively administered ICG becomes clearly detectable under ICG uorography; however, it remains unclear whether this detection method is always reliable. This case series study was designed to clarify the reliability of this method. Methods ICG (0.5 mg/kg) was injected from the 3rd to 28th preoperative day to evaluate hepatic function in 58 patients with HCCs. Preoperative imaging modalities identied 76 HCC foci. The operative elds and resected specimens were observed with an NIR camera system. Preoperatively detected lesions and lesions newly detected by the ICG uorography were histologically investigated. Results ICG uorography identied 73 of 76 preoperatively diagnosed HCC lesions. Intraoperative ICG uorography visualized 47 lesions in 40 patients. The other 26
lesions showing emission were found in the sectioned specimens under NIR observation. Other than preoperatively diagnosed foci, ICG uorography visualized 35 new lesions, including 6 HCCs, 2 dysplastic nodules and 27 non-neoplastic lesions, such as bile plugs and cysts. The sensitivity of ICG uorography for HCCs was 96% and its positive predictive value was 71.5%.
Conclusions Indocyanine green uorography is useful to detect HCCs; however, attention should be paid to the fact that HCCs may be occasionally overlooked by this imaging method and that lesions detected by this method are not always neoplastic lesions.
Keywords Near-infrared ICG uorography
Hepatocellular carcinoma
AbbreviationsCT Computed tomographyCTHA CT during hepatic arteriographyFFPE Formalin xed and parafn embeddedHCC Hepatocellular carcinomasICG Indocyanine greenMDR3 Multidrug resistance P-glycoprotein 3MRI Magnetic resonance imagingNIR Near-infraredNTCP Na?-taurocholate co-transporting polypeptide OATP Organ anion transporting polypeptide
Introduction
Despite advances in radiographic diagnostic modalities, preoperatively unidentied liver tumors are occasionally found during hepatectomy [1]. In particular, small
Y. Morita (&) T. Sakaguchi N. Unno Y. Shibasaki
A. Suzuki K. Fukumoto K. Inaba...