625 INDOCYANINE GREEN CANNOT PREDICT MALIGNANCY IN ROBOTIC PARTIAL NEPHRECTOMY: HISTOPATHOLOGIC CORRELATION IN 100 PATIENTS

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (I)1 Apr 2013625 INDOCYANINE GREEN CANNOT PREDICT MALIGNANCY IN ROBOTIC PARTIAL NEPHRECTOMY: HISTOPATHOLOGIC CORRELATION IN 100 PATIENTS Ted Manny, L Spencer Krane, and Ashok Hemal Ted MannyTed Manny Winston Salem, NC More articles by this author , L Spencer KraneL Spencer Krane Winston Salem, NC More articles by this author , and Ashok HemalAshok Hemal Winston Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.177AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Indocyanine Green (ICG) is emerging as a potential adjunct to robot assisted partial nephrectomy (RAPN) by its ability to help in the real-time identification of renal vasculature and the neoplasm-parenchymal margin. It has been previously hypothesized that mass hypofluorescence may predict malignant histology. Early in our experience of ICG partial nephrectomy we noted heterogeneity in fluorescence patterns and began to question this hypothesis. In this analysis we describe the correlation of three distinct fluorescence patterns (isofluorescent, hypofluorescent, and afluorescent) with tumor histology in a consecutive series of ICG partial nephrectomies. METHODS We reviewed our prospective ICG database of the first 100 cases of RAPN and categorized them according to histologic subtype and one of three fluorescence patterns patterns (isofluorescnce, hypofluorescnce, and afluorescence). Descriptive statistics were applied. To test the potential performance of ICG hypofluoresence as a test of malignancy, we determined sensitivity, specificity, positive and negative predictive values considering hypofluorescence as a positive test and isofluorescence or afluorescence as negative. RESULTS Eighty-six masses were solid which included 75 hypofluorescent lesions (65 malignant, 10 benign), 3 isofluorescent lesions (2 clear cell, one translocation tumor), and 8 afluorescent lesions (all angiomyolipoma). All 14 cystic lesions were afluorescent, and comprised 9 malignant and 5 benign tumors. Clear cell was the most common histology of which the majority was hypofluorescent (Fig 1). In terms of determining malignant vs. benign lesions, hypofluorescence had a positive predictive value of 87%, negative predictive value of 52%, sensitivity of 84% and specificity of 57%. CONCLUSIONS A three tiered grading system of ICG fluorescence is correlated with some histologic findings but unable to reliably predict malignant versus benign lesions. ICG hypofluorescence should not be used as a test of malignancy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e255 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ted Manny Winston Salem, NC More articles by this author L Spencer Krane Winston Salem, NC More articles by this author Ashok Hemal Winston Salem, NC More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...