Abstract
BackgroundReports detailing microscopic observations of indocyanine green (ICG) fluorescence imaging (IFI) in hepatocellular carcinoma (HCC) and metastatic liver cancer are rare. We were able to perform macro- and microscopic IFI results in postoperative paraffin-embedded tissue samples and formalin-fixed specimens from liver tumors.MethodsBetween April 2010 and March 2014, 19 patients with HCC or liver metastases of colorectal tumors underwent liver resection. ICG solution was injected into the peripheral vein from 14 to 2 days prior to operation. We observed liver tumor IFI during the laparotomy and IFI in resected liver sections using a photo dynamic emission (PDE) camera. The IFI of paraffin-embedded tissue samples was observed using a charge-coupled device (CCD) camera. Moreover, we microscopically performed tissue section IFI using a fluorescence microscope with an ICG-B-NQF.ResultsWe performed that IFI characteristics depended on tumor type macroscopically and microscopically. In normal liver tissue, fluorescence consistent with the bile canaliculus was observed. HCC had heterogeneous IFI, forming a total or partial tumor and rim pattern. In metastatic carcinoma, we performed that non-tumor cells in the marginal region showed fluorescence and tumor cells in the central region did not fluoresce.ConclusionsWe confirmed that the variations of ICG fluorescence imaging patterns reflect different tumor characteristics in not only macroscopic imaging as previous reports but also microscopic imaging. Moreover, the ICG fluorescence method is useful for postoperative pathological detection of microscopic lesions in histopathological specimens. ICG fluorescence in paraffin-embedded tissue samples and formalin-fixed specimens is preserved in the long term.
Highlights
Reports detailing microscopic observations of indocyanine green (ICG) fluorescence imaging (IFI) in hepatocellular carcinoma (HCC) and metastatic liver cancer are rare
In case No 10, we were able to detect and resect by using ICG fluorescence imaging (IFI) the main tumor and small metastases, which were not identified with the preoperative imaging
We confirmed that the variations of ICG fluorescence imaging patterns reflect different tumor characteristics in macroscopic imaging as previous reports [10, 22] and microscopic imaging
Summary
Reports detailing microscopic observations of indocyanine green (ICG) fluorescence imaging (IFI) in hepatocellular carcinoma (HCC) and metastatic liver cancer are rare. We were able to perform macro- and microscopic IFI results in postoperative paraffin-embedded tissue samples and formalin-fixed specimens from liver tumors. ICG fluorescence imaging (IFI) is increasingly being used in fluorescence-guided surgery, i.e., in breast [2], gastric [3, 4], and esophageal cancer [5] surgeries and vascular surgery [6]. Some institutions have recently reported IFI macroscopic features in hepatocellular carcinoma (HCC) and metastatic liver tumors [10,11,12,13]. We performed macro- and microscopic IFI characteristics in liver tumors using postoperative paraffin-embedded tissue and formalin-fixed specimens
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