title: Evaluation of fluorescence imaging with indocyanine green in hepatocellular carcinoma.
abstract: BACKGROUND
  We hypothesized that indocyanine green (ICG) fluorescence patterns using Clairvivo OPT in resected liver specimens could confirm hepatocellular carcinoma (HCC) better than earlier commercial imaging systems. This preclinical trial evaluated the effectiveness of fluorescence imaging as an intraoperative cancer navigation tool.
  
  
  METHODS
  ICG fluorescence images of resected specimens from 190 patients with HCC were classified into two groups according to whether high fluorescence was seen in the HCC (high cancerous [HC] group) or in the surrounding liver tissue (high surrounding [HS] group). The HC and HS groups were sub-classified into whole and partial types and whole and ring types, respectively.
  
  
  RESULTS
  The HC group had significantly higher prevalence of esophageal or gastric varices, and worse liver function than patients in the HS group. The HC group also had a higher percentage of limited resection cases than did the HS group. Cirrhotic liver histology was significantly more common in the HC group than in the HS group. Multivariate analysis revealed that the HC group was a predictive factor for cirrhosis in HCC patients. Among the HC patients, a higher percentage of well-differentiated HCC cases were seen in the partial-type subgroup than in the whole-type subgroup (23/48 (48 %) vs. 7/68 (10 %)). In the HS group, the ring-type subgroup had a higher percentage of poorly differentiated HCC cases than did the whole-type subgroup (6/37 (16 %) vs. 0/37 (0 %)).
  
  
  CONCLUSIONS
  Tumor differentiation and fibrosis in the non-cancerous liver parenchyma could affect ICG fluorescence imaging in HCC. ICG fluorescence imaging may be a good indication for fibrosis stage. In future, we will try to evaluate fluorescence imaging with ICG for intraoperative cancer navigation in HCC, using a portable near-infrared fluorescence imaging system.
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan. kaibori@hirakata.kmu.ac.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kaibori
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Morihiko
authors.initials: M
authors.lastname: Ishizaki
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Iida
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Tatsuma
authors.initials: T
authors.lastname: Sakaguchi
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Tsuda
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Okumura
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Department of Surgery, Japan Labour Health and Welfare Organization Kushiro Rosai Hospital, Kushiro, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Shimada
authors.affiliation: Department of Oral and Maxillofacial Surgery, Japan Labor Health and Welfare Organization Kushiro Rosai Hospital, Kushiro, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtsubo
authors.affiliation: Department of Surgery, Seiwa Memorial Hospital, Sapporo, Hokkaido, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kusano
authors.affiliation: Research Centre for Medical Glycoscience, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Ikehara
authors.affiliation: Technology Research Laboratory, Shimadzu Corporation, Kyoto, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ozeki
authors.affiliation: Department of Mathematics, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kitawaki
authors.affiliation: Department of Surgery, Hirakata Hospital, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kon
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents / Q000008:administration & dosage; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007259:Infrared Rays; D007430:Intraoperative Care; D054023:Lasers, Semiconductor; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008297:Male; D008856:Microscopy, Fluorescence / Q000295:instrumentation; D008875:Middle Aged; D061848:Optical Imaging / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Fibrosis stage; Hepatic resection; Hepatocellular carcinoma; Indocyanine green fluorescence imaging