Near-infrared intraoperative imaging for minimally invasive pulmonary metastasectomy for sarcomas.

Authors

• Jarrod D Predina
• Andrew D Newton
• Christopher Corbett
• Michael Shin
• Lydia Frenzel Sulfyok
• Olugbenga T Okusanya
• Edward J Delikatny
• Shuming Nie
• Colleen Gaughan
• Doraid Jarrar
• Taine Pechet
• John C Kucharczuk
• Sunil Singhal

Publication/Presentation Date

5-1-2019

Abstract

BACKGROUND: Complete pulmonary metastasectomy for sarcoma metastases provides patients an opportunity for long-term survival and possible cure. Intraoperative localization of preoperatively identified metastases and identification of occult lesions can be challenging. In this trial, we evaluated the efficacy of near-infrared (NIR) intraoperative imaging using second window indocyanine green during metastasectomy to identify known metastases and to detect occult nodules.

METHODS: Thirty patients with pulmonary nodules suspicious for sarcoma metastases were enrolled in an open-label, feasibility study (NCT02280954). All patients received intravenous indocyanine green (5 mg/kg) 24 hours before metastasectomy. Patients 1 through 10 (cohort 1) underwent metastasectomy via thoracotomy to assess fluorescence patterns of nodules detected by traditional methods (preoperative imaging and intraoperative visualization/bimanual palpation). After confirming reliability within cohort 1, patients 11 through 30 (cohort 2) underwent video-assisted thoracic surgery metastasectomy with NIR imaging.

RESULTS: In cohort 1, 14 out of 16 preoperatively identified pulmonary metastases (87.5%) displayed tumor fluorescence. Nonfluorescent metastases were deeper than fluorescent metastases (2.1 cm vs 1.3 cm; P = .03). Five out of 5 metastases identified during thoracotomy displayed fluorescence. NIR imaging identified 3 additional occult lesions in this cohort. In cohort 2, 33 out of 37 known pulmonary metastases (89.1%) displayed fluorescence. Nonfluorescent tumors were deeper than 2.0 cm (P = .007). NIR imaging identified 24 additional occult lesions. Of 24 occult lesions, 21 (87.5%) were confirmed metastases and the remaining 3 nodules were lymphoid aggregates.

CONCLUSIONS: NIR intraoperative imaging with indocyanine green (5 mg/kg and 24 hours before surgery) localizes known sarcoma pulmonary metastases and identifies otherwise occult lesions. This approach may be a useful intraoperative adjunct to improve metastasectomy.

Volume

157

Issue

5

First Page

2061

Last Page

2069

ISSN

1097-685X

Published In/Presented At

Predina, J. D., Newton, A. D., Corbett, C., Shin, M., Sulfyok, L. F., Okusanya, O. T., Delikatny, E. J., Nie, S., Gaughan, C., Jarrar, D., Pechet, T., Kucharczuk, J. C., & Singhal, S. (2019). Near-infrared intraoperative imaging for minimally invasive pulmonary metastasectomy for sarcomas. The Journal of thoracic and cardiovascular surgery, 157(5), 2061–2069. https://doi.org/10.1016/j.jtcvs.2018.10.169

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

31288365

Department(s)

Administration and Leadership

Document Type

Article