title: Combined use of intraoperative ultrasound and indocyanine green fluorescence imaging to detect liver metastases from colorectal cancer.
abstract: OBJECTIVE
  Surgical excision is the standard strategy for managing liver metastases from colorectal carcinoma. The achievement of negative (R0) margins is a major determinant of disease-free survival in these patients. Current imaging techniques are of limited value in achieving this goal. A new approach to the intraoperative detection of colorectal liver metastatic tissue based on the emission of indocyanine green (ICG) fluorescence was evaluated.
  
  
  METHODS
  A total of 25 consecutive patients with liver metastases from primary colorectal cancers who were eligible for liver resection received a bolus of ICG (0.5 mg/kg body weight) 24 h before surgery. During surgery, ICG fluorescence, which accumulates around lesions as a result of defective biliary clearance, was detected with a near-infrared camera system, the Photodynamic Eye (PDE). Numbers of lesions detected by, respectively, PDE + ICG, intraoperative ultrasound (IOUS) and preoperative computed tomography (CT) were recorded.
  
  
  RESULTS
  The near-infrared camera plus ICG revealed a total of 77 metastatic liver nodules. Preoperative CT demonstrated 45 (58.4%) and IOUS showed 55 (71.4%). Preoperative CT and IOUS alone were inferior to the combined use of PDE + ICG and IOUS in the detection of lesions of ≤ 3 mm in size.
  
  
  CONCLUSIONS
  This experience suggests that PDE + ICG, combined with IOUS, may represent a safe and effective tool for ensuring the complete surgical eradication of liver metastases from colorectal cancer.
authors: General Surgery, Fondazione IRCCS Policlinico San Matteo Pavia and University of Pavia, Pavia, Italy.
authors: Andrea
authors: A
authors: Peloso
authors: Eloisa
authors: E
authors: Franchi
authors: Maria C
authors: MC
authors: Canepa
authors: Letizia
authors: L
authors: Barbieri
authors: Laura
authors: L
authors: Briani
authors: Jacopo
authors: J
authors: Ferrario
authors: Carolina
authors: C
authors: Bianco
authors: Pietro
authors: P
authors: Quaretti
authors: Silvia
authors: S
authors: Brugnatelli
authors: Paolo
authors: P
authors: Dionigi
authors: Marcello
authors: M
authors: Maestri
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D005456:Fluorescent Dyes; D006498:Hepatectomy; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D057054:Molecular Imaging / Q000379:methods*; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging / Q000379:methods*; D061206:Neoplasm Micrometastasis; D011237:Predictive Value of Tests; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005456:Fluorescent Dyes; D007208:Indocyanine Green