IPEG 2020 TOP ABSTRACT: Thoracoscopic Pulmonary Metastasectomy for Hepatoblastoma Using Indocyanine Green

Resection of pulmonary lesions in metastatic hepatoblastoma presents technical difficulties in both localization and surgical resection.

ICG dye has known affinity for hepatocytes.

ICG was injected systemically at a dose of 0.5 mg per kilogram approximately 24 hours prior to scheduled surgery.

Three different imaging modes were used to identify lesions with ICG uptake: spy overlay, spy contrast, and spy envy.

Several unexpected pulmonary lesions were identified using ICG fluorescence technology that were not appreciated on initial CT imaging.

The child was discharged on the 3rd postoperative day.

Pathology revealed a 0.2 centimeter mass surrounded by healthy parenchymal tissue with sheets and cords of polygonal cells with round nuclei and mild pleomorphism consistent with metastatic lesion.

Immunohistochemistry for hep par 1 illustrated uptake by the metastatic hepatoblastoma tissue due to affinity for hepatocytes.

On preoperative CT scan, 3 left-sided lesions and 2 right-sided lesions were expected, but 8 total lesions were identified and removed using ICG dye.

The higher sensitivity and detection of metastatic pulmonary hepatoblastoma by utilization of ICG dye and fluorescent imaging allows for parenchymal sparing and minimally invasive resection.

Traditional methods such as wire localization may be necessary for lesions deeper than 1.5 centimeters.

The use of ICG to identify superficial metastatic lesions is a developing technology with significant clinical application.