title: Usefulness of intraoperative diagnosis of hepatic tumors located at the liver surface and hepatic segmental visualization using indocyanine green-photodynamic eye imaging.
abstract: BACKGROUND
  To improve the diagnostic accuracy for hepatic tumors on the liver surface, we investigated the usefulness of an indocyanine green-photodynamic eye (ICG-PDE) system by comparison with Sonazoid intraoperative ultrasonography (IOUS) in 117 patients. Hepatic segmentation by ICG-PDE was also evaluated.
  
  
  METHODS
  ICG was administered preoperatively for functional testing and images of the tumor were observed during hepatectomy using a PDE camera. ICG was injected into portal veins to determine hepatic segmentation.
  
  
  RESULTS
  Accurate diagnosis of liver tumors was achieved with ICG-PDE in 75% of patients, lower than with IOUS (94%). False-positive and false-negative diagnosis rates for ICG-PDE were 24% and 9%, respectively. New small HCCs were detected in 3 patients. The ICG fluorescent pattern in tumors was strong staining in 41%, weak staining in 13%, rim staining in 20% and no staining in 26%. Hepatocellular carcinoma predominantly showed strong staining (61%), while rim staining predominated in cholangiocellular carcinoma (60%) and liver metastasis (55%). Hepatic segmental staining was performed in 28 patients, proving successful in 89%.
  
  
  CONCLUSIONS
  ICG-PDE is a useful tool for detecting the precise tumor location at the liver surface, identifying new small tumors, and determining liver segmentation for liver resection.
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Abo
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: a-nanasm@nagasaki-u.ac.jp.
authors.forename: A
authors.initials: A
authors.lastname: Nanashima
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Tobinaga
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hidaka
authors.affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Taura
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Arai
authors.affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miyaaki
authors.affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Shibata
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000601:surgery; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D015179:Colorectal Neoplasms / Q000473:pathology*; D003287:Contrast Media; D005188:False Negative Reactions; D005189:False Positive Reactions; D005240:Feasibility Studies; D005260:Female; D005290:Ferric Compounds; D005456:Fluorescent Dyes; D005706:Gallbladder Neoplasms / Q000473:pathology*; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care; D007501:Iron; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology*; D010087:Oxides; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D005456:Fluorescent Dyes; D010087:Oxides; C069727:Sonazoid; D007501:Iron; D007208:Indocyanine Green
keywords: Hepatectomy; Indocyanine green; Liver tumor; Navigation; Photodynamic eye