The Use of Indocyanine Green to Identify Endometriosis Intraoperatively [34B

Abstract

INTRODUCTION: The gold standard for diagnosis of endometriosis is a tissue biopsy. Endometriosis can be a debilitating cause of pelvic pain. Since symptoms can be nonspecific, presumptive diagnosis without tissue biopsy may be difficult. Recently, indocyanine green (ICG), a fluorescent dye that identifies vascular areas, has been used to help identify the vascular lesions of endometriosis, specifically the “clear” lesions that can easily be missed during surgery. METHODS: A retrospective chart review and data analysis was performed on patients upon whom ICG was used from July 2014 to January 2019. Preoperative symptoms, including abnormal uterine bleeding, pelvic pain, dyspareunia, and fibroids were analyzed using Fisher exact test. identification of “clear” lesions with ICG was analyzed using Fisher exact test. RESULTS: Of 56 patients who underwent laparoscopic excision of endometriosis with ICG, 46 with positive fluorescence had pathology-confirmed endometriosis; 10 had negative pathology with no ICG fluorescence and 10 had fluorescence but no endometriosis. This indicates a positive predictive value of 82% and a sensitivity of 100%. There was no statistically significant difference with preoperative symptoms. Clear lesions were identified using ICG in 100% of patients with endometriosis; however, there was no statistically significant difference when compared to patients without endometriosis. CONCLUSION: ICG dye utilization offered a diagnosis of endometriosis in 46 of 56 patients. ICG is safe, inexpensive, and may help physicians diagnose endometriosis. Additional patients should be recruited to add power to the data. A future research study could analyze the possible differences in uptake of ICG in different stages of endometriosis.