Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility study
Background: In osteosarcoma patients, resection of pulmonary metastases is considered necessary for long term survival. Radiologically detected lesions are sometimes difficult to identify intraoperatively, especially when no palpation is possible during thoracoscopy. In adults, fluorescence guided s...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | EJC Paediatric Oncology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772610X2300017X |
| _version_ | 1797345844002816000 |
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| author | Bernadette Jeremiasse Caroline C.C. Hulsker Ceder H. van den Bosch Myrthe A.D. Buser Cornelis P. van der Ven Guus M.J. Bökkerink Marc H.W.A. Wijnen Alida F.W. Van der Steeg |
| author_facet | Bernadette Jeremiasse Caroline C.C. Hulsker Ceder H. van den Bosch Myrthe A.D. Buser Cornelis P. van der Ven Guus M.J. Bökkerink Marc H.W.A. Wijnen Alida F.W. Van der Steeg |
| author_sort | Bernadette Jeremiasse |
| collection | DOAJ |
| description | Background: In osteosarcoma patients, resection of pulmonary metastases is considered necessary for long term survival. Radiologically detected lesions are sometimes difficult to identify intraoperatively, especially when no palpation is possible during thoracoscopy. In adults, fluorescence guided surgery (FGS) using indocyanine green (ICG) has been shown to be a safe method for intra-operative identification of pulmonary metastases of different primary tumors. Our aim is to determine the feasibility of using ICG for identification of pulmonary metastases in pediatric osteosarcoma patients. Methods: Nine consecutive patients with pulmonary metastases received an intravenous dose of ICG 24 h preoperatively. We started with the adult dosage of 0.5 mg/kg and also used 1.0 mg/kg to confirm that maximum fluorescent signal was achieved. Intra-operatively and post-operatively, lesions were visualized with a near-infrared camera system. Fluorescence was quantified by calculating a tumor-to-background ratio (TBR). Results: Two (22%) patients underwent a thoracoscopy and seven (78%) underwent a thoracotomy. Five (56%) patients had a fluorescent metastasis during surgery. In four (44%) patients there were no fluorescent metastases. In two the metastases were necrotic. In the other two, intraoperative fluorescence was most likely hampered by the depth of the metastases. Ex vivo, all vital metastases were fluorescent and necrotic specimens were not. There was no difference between 1.0 mg/kg and 0.5 mg/kg concerning TBR. No adverse events occurred. Conclusions: ICG for fluorescence guided metastasectomy of pulmonary osteosarcoma is a feasible procedure in the pediatric population. However, its additional value in intra-operative guidance still has to be investigated. Levels of evidence: Level III evidence based on a Diagnostic test study: study without a universally applied “gold” standard. |
| first_indexed | 2024-03-08T11:23:33Z |
| format | Article |
| id | doaj.art-409dd32fe7e54c1d87253dd3560fcd0f |
| institution | Directory Open Access Journal |
| issn | 2772-610X |
| language | English |
| last_indexed | 2024-03-08T11:23:33Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJC Paediatric Oncology |
| spelling | doaj.art-409dd32fe7e54c1d87253dd3560fcd0f2024-01-26T05:38:33ZengElsevierEJC Paediatric Oncology2772-610X2023-12-012100019Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility studyBernadette Jeremiasse0Caroline C.C. Hulsker1Ceder H. van den Bosch2Myrthe A.D. Buser3Cornelis P. van der Ven4Guus M.J. Bökkerink5Marc H.W.A. Wijnen6Alida F.W. Van der Steeg7Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsPrincess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsPrincess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsPrincess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsPrincess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsPrincess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsPrincess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsCorresponding author.; Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, the NetherlandsBackground: In osteosarcoma patients, resection of pulmonary metastases is considered necessary for long term survival. Radiologically detected lesions are sometimes difficult to identify intraoperatively, especially when no palpation is possible during thoracoscopy. In adults, fluorescence guided surgery (FGS) using indocyanine green (ICG) has been shown to be a safe method for intra-operative identification of pulmonary metastases of different primary tumors. Our aim is to determine the feasibility of using ICG for identification of pulmonary metastases in pediatric osteosarcoma patients. Methods: Nine consecutive patients with pulmonary metastases received an intravenous dose of ICG 24 h preoperatively. We started with the adult dosage of 0.5 mg/kg and also used 1.0 mg/kg to confirm that maximum fluorescent signal was achieved. Intra-operatively and post-operatively, lesions were visualized with a near-infrared camera system. Fluorescence was quantified by calculating a tumor-to-background ratio (TBR). Results: Two (22%) patients underwent a thoracoscopy and seven (78%) underwent a thoracotomy. Five (56%) patients had a fluorescent metastasis during surgery. In four (44%) patients there were no fluorescent metastases. In two the metastases were necrotic. In the other two, intraoperative fluorescence was most likely hampered by the depth of the metastases. Ex vivo, all vital metastases were fluorescent and necrotic specimens were not. There was no difference between 1.0 mg/kg and 0.5 mg/kg concerning TBR. No adverse events occurred. Conclusions: ICG for fluorescence guided metastasectomy of pulmonary osteosarcoma is a feasible procedure in the pediatric population. However, its additional value in intra-operative guidance still has to be investigated. Levels of evidence: Level III evidence based on a Diagnostic test study: study without a universally applied “gold” standard.http://www.sciencedirect.com/science/article/pii/S2772610X2300017XFluorescence guided surgeryNear-infrared fluorescence imagingIndocyanine greenPulmonary metastasectomyOsteosarcomaPediatric patients |
| spellingShingle | Bernadette Jeremiasse Caroline C.C. Hulsker Ceder H. van den Bosch Myrthe A.D. Buser Cornelis P. van der Ven Guus M.J. Bökkerink Marc H.W.A. Wijnen Alida F.W. Van der Steeg Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility study EJC Paediatric Oncology Fluorescence guided surgery Near-infrared fluorescence imaging Indocyanine green Pulmonary metastasectomy Osteosarcoma Pediatric patients |
| title | Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility study |
| title_full | Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility study |
| title_fullStr | Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility study |
| title_full_unstemmed | Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility study |
| title_short | Fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients: A feasibility study |
| title_sort | fluorescence guided surgery using indocyanine green for pulmonary osteosarcoma metastasectomy in pediatric patients a feasibility study |
| topic | Fluorescence guided surgery Near-infrared fluorescence imaging Indocyanine green Pulmonary metastasectomy Osteosarcoma Pediatric patients |
| url | http://www.sciencedirect.com/science/article/pii/S2772610X2300017X |
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