ICG-fluorescence imaging for detection of peritoneal metastases and residual tumoral scars in locally advanced ovarian cancer: A pilot study

Isabelle Veys, Florin-Catalin Pop, Sophie Vankerckhove, Romain Barbieux, Marie Chintinne, Michel Moreau, Jean-Marie Nogaret, Denis Larsimont, Vincent Donckier, Pierre Bourgeois, Gabriel Liberale

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Abstract

Background and Objectives:
No intraoperative imaging techniques exist for detecting tumor nodules or tumor scar tissues in patients treated with upfront or interval cytoreductive surgery (CS) after neoadjuvant chemotherapy (NAC). The aims of this study were to evaluate the role of indocyanine green (ICG) fluorescence imaging (FI) for the detection of peritoneal metastases (PM) and evaluate whether it can be used to detect remnant tumor cells in scar tissue.

Methods:
Patients with PM from ovarian cancer admitted for CS were included. ICG, at 0.25 mg per kg of patient weight, was injected intraoperatively after explorative laparotomy before CS.

Results:
A total of 108 peritoneal lesions, including 25 scars, were imaged in 20 patients. Seventy‐three were malignant (67.6%) and 35 benign (32.4%). The mean Tumor to Background Ratio (ex vivo) was 1.8 (SD 1.3) in malignant and 1.0 (SD 0.79) in benign nodules (P = 0.007). Of 25 post‐NAC scars, the mean Tumor to Background Ratio (TBR) (in vivo) was 2.06 (SD 1.15) in malignant and 1.21 (SD 0.50) in benign nodules (P = 0.26). The positive predictive value of ICG‐FI to detect tumor cells in scars was 57.1%.

Conclusions:
ICG‐FI is accurate to demonstrate PM in ovarian cancer but unable to discriminate between benign and malignant post‐NAC.
Original languageEnglish
Pages (from-to)228-235
Number of pages8
JournalJournal of Surgical Oncology
Volume117
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

Keywords

  • ex vivo
  • imaging
  • in vivo
  • indocyanine green
  • intraoperative fluorescence imaging
  • neoadjuvant chemotherapy
  • ovarian neoplasm
  • peritoneal metastasis
  • residual tumoral scars

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