Pathological Validity of Using Near-infrared Fluorescence Imaging for Securing Surgical Margins During Liver Resection

Abstract

Background/aim: This study investigated the use of near-infrared fluorescent imaging for securing safe margins during liver resection.

Patients and methods: This study included 125 patients who underwent liver tumor resection in 2014-2018. Indocyanine green testing was performed 2-14 days before surgery. Histopathological specimens of hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) were evaluated using fluorescent microscopy.

Results: Fluorescence microscopy identified signals in 26/53 (49.0%) and 36/72 (50%) cases of HCC and CRLM, respectively. HCC demonstrated total, partial, rim, and combined fluorescence patterns; CRLM uniformly demonstrated rim fluorescence. Although rim fluorescence was seen in both HCC and CRLM, no malignancy was confirmed pathologically in the peritumoral area demonstrating fluorescence. The median widths of fluorescence from the tumor edge in HCC and CRLM were 1227.5 μm and 1608 μm, respectively, with no significant difference.

Conclusion: Near-infrared fluorescent imaging can reliably detect safe surgical margins intraoperatively during liver resection.

Keywords: ICG fluorescence-guided surgery; Surgical margin; fluorescence pattern; fluorescence width; laparoscopic liver resection.