Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma
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- - ICG fluorescence imaging achieved 91% sensitivity in identifying metastatic hepatoblastoma lesions across 120 thoracic specimens. - In 10% of operations, hepatoblastoma-positive specimens were resected based solely on ICG-avidity without preoperative imaging detection. - ICG assisted in tumor localization in 50% of cases, proving valuable for detecting occult lesions not visible on preoperative imaging. - False positives limit ICG specificity to 57%, but no adverse outcomes resulted from additional resections guided by ICG findings. - Thoracoscopic surgery is safe for lower disease burden cases, with straightforward conversion to thoracotomy when needed.
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Are you actually seeing all the hepatoblastoma during your resection? Hi, I'm Doctor Sophia Schermerhorn from Cincinnati Children's, and this study looks at how ICG can help visualization of both local and metastatic hepatoblastoma at the time of surgery. This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatolasts. The key finding is that ICG was highly sensitive for detecting hepatoblastoma, about 90%. Importantly, in a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging, which means that these lesions would have been missed otherwise. That being said, specificity was lower than sensitivity with false positives. Often representing vascular changes or inflammation. Notably, there's no adverse outcomes associated with any of these additional resections. ICG was effective in both open and minimally invasive surgery and in both relapse and primary disease. Key takeaway is that ICG is a valuable tool that can help increase confidence in achieving a complete resection for both primary and metastatic hepatoblastoma.