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.

Spy overlay mode displays a green fluorescent lesion on a white light image.

Spy contrast mode reveals a bright white lesion against a dark background.

Spy envy mode uses fluorescent imaging with a gray scale background.

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

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 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.

ICG fluorescence imaging demonstrates higher sensitivity in detection of metastatic pulmonary hepatoblastoma compared to CT imaging.

ICG allows for parenchymal sparing and minimally invasive resection of metastatic pulmonary hepatoblastoma.

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

ICG use for identifying superficial metastatic lesions is a developing technology with significant clinical application.