NEW YORK (Reuters Health) – Inhalational indocyanine green (ICG) can be useful for the intraoperative visualization of lung-tumor margin, researchers from South Korea report.
Surgical resection with adequate tumor-free margin offers optimal long-term survival in patients with early-stage non-small-cell lung cancer (NSCLC), but specifying the tumor margin during surgical treatment can be difficult.
Dr. Hyun Koo Kim of Korea University’s Guro Medical facility and College of Medication, in Seoul, and coworkers describe their intraoperative strategy of using near-infrared (NIR) fluorescence after inhalation of ICG to visualize lung growth margin in mouse and rabbit designs and in lung specimens of human beings with lung cancer.
In healthy mice, inhaled ICG accumulated preferentially in the lungs, although fluorescence signals were present at lower levels in the liver and brain.
In a mouse design of lung cancer, breathed in ICG was found in healthy tissue however not in the lung growth, the scientists report in JAMA Surgical treatment.
Likewise, in a rabbit lung-tumor model, intraoperative NIR florescence imaging recognized ICG only in healthy tissue, which assisted in visualization of the tumor margin and growth resection at one hour postinhalation.
On the other hand, when ICG was injected intravenously, considerable differences in florescence emerged just at 24 hours postinjection.
In human lung specimens, the ICG florescence signal was found primarily in the noncancerous tissues, and the growth margin was plainly pictured in all specimens.
” This strategy appears to assist in fast and extended visualization of the growth margin of a lung tumor on the pleural surface area with a low dosage of ICG, which can not be achieved utilizing the intravenous injection approach,” the authors conclude. “We suggest that the ICG inhalation approach will not just supply more accurate resection of lung growths however likewise might enhance client security during surgery.”
Dr. Joseph D. Phillips of Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire, who coauthored a welcomed commentary on the findings, told Reuters Health by email, “The ability to spot surgical margins with inhalational ICG is quite fascinating, as it opens the possibility for the detection of small, non-palpable nodules near the edge of the lung or other locations of ground glass opacities that may be tough to palpate or distinguish without making use of this technology.”
” Surgical methods ought to be constantly assessed for improvement,” he stated. “The authors of this research study showed an ‘outside the box’ method and have demonstrated excellent preliminary findings for a possibly appealing method.”
” While the evidence kept in mind in the existing study used larger nodules than would clinically be required for usage with this method, it does offer proof of concept for future studies that will be required to additional assess the ability to spot smaller sized locations of issue in the lung,” Dr. Phillips stated.
Dr. Kim and co-author Dr. Ji-Ho Park did not respond to a request for remarks.
SOURCE: https://bit.ly/3ibOeQx and https://bit.ly/2BQDTZu JAMA Surgery, online June 24, 2020.