title: Intraoperative near-infrared imaging can identify pulmonary nodules.
abstract: BACKGROUND
  Over 80,000 people undergo pulmonary resection for a lung nodule in the United States each year. Small nodules are frequently missed or difficult to find despite preoperative imaging. We hypothesized that near-infrared (NIR) imaging technology could be used to identify and locate lung nodules during surgery.
  
  
  METHODS
  We enrolled 18 patients who were diagnosed with a pulmonary nodule that required resection. All patients had a fine-cut 1-mm computed tomography scan preoperatively. The patients were given systemic 5 mg/kg indocyanine green and then underwent an open thoracotomy 24 hours later. The NIR imaging was used to identify the primary nodule and search for additional nodules that were not found by visual inspection or manual palpation of the ipsilateral lung.
  
  
  RESULTS
  Manual palpation and visual inspection identified all 18 primary pulmonary nodules and no additional lesions. Intraoperative NIR imaging detected 16 out of the 18 primary nodules. The NIR imaging also identified 5 additional subcentimeter nodules; 3 metastatic adenocarcinomas and 2 metastatic sarcomas. This technology could identify nodules as small as 0.2 cm and as deep as 1.3 cm from the pleural surface. This approach discovered 3 nodules that were in different lobes than the primary tumor. Nodule fluorescence was independent of size, metabolic activity, histology, tumor grade and vascularity.
  
  
  CONCLUSIONS
  This is the first-in-human demonstration of identifying pulmonary nodules during thoracic surgery with NIR imaging without a priori knowledge of their location or existence. The NIR imaging can detect pulmonary nodules during lung resections that are poorly visualized on computed tomography and difficult to discriminate on finger palpation.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Olugbenga T
authors.initials: OT
authors.lastname: Okusanya
authors.affiliation: Department of Pathology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Holt
authors.affiliation: Georgia Institute of Technology, Atlanta, Georgia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Heitjan
authors.affiliation: Department of Clinical Studies, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania.
authors.forename: Charuhas
authors.initials: C
authors.lastname: Deshpande
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Ollin
authors.initials: O
authors.lastname: Venegas
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jack
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Ryan
authors.initials: R
authors.lastname: Judy
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: DeJesus
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Brian
authors.initials: B
authors.lastname: Madajewski
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Kenny
authors.initials: K
authors.lastname: Oh
authors.affiliation: Georgia Institute of Technology, Atlanta, Georgia.
authors.forename: May
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Albelda
authors.affiliation: Departments of Biomedical Engineering and Chemistry, Emory University, Atlanta, Georgia.
authors.forename: Shuming
authors.initials: S
authors.lastname: Nie
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: sunil.singhal@uphs.upenn.edu.
authors.forename: Sunil
authors.initials: S
authors.lastname: Singhal
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008168:Lung / Q000473:pathology; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D011013:Pneumonectomy; D003074:Solitary Pulmonary Nodule / Q000098:blood supply / Q000175:diagnosis* / Q000473:pathology
chemical_list: D007208:Indocyanine Green
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