# Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma — GCMD Library Charissa M Lake, Alexander J Bondoc, Roshni Dasgupta, Todd M Jenkins, Alexander J Towbin, Ethan A Smith, Maria H Alonso, James I Geller, Gregory M Tiao

Background: Hepatoblastoma is the most common primary pediatric liver malignancy. Indocyanine green (ICG) has been described as an adjunct to resection in small series. Its utility remains undefined in larger cohorts.

Methods: Records for 29 patients diagnosed with hepatoblastoma who received ICG prior to surgical resection from 2017 to 2020 at a single institution were retrospectively reviewed. The primary outcome was correlation between intraoperative ICG-avidity and histologic presence of hepatoblastoma. A secondary outcome included the histologic margin designation for resected liver specimens.

Results: ICG sensitivity was 91% for 120 resected thoracic specimens from 21 patients. Specificity was 57%. In 10% of operations, HB-positive specimens were resected solely on ICG-avidity. In an additional 40% of cases, ICG assisted in localizing a preoperatively diagnosed lesion. ICG sensitivity during thoracotomy and thoracoscopic surgery was 95 and 74%, respectively; primary and relapsed disease demonstrated sensitivity of 94 and 73%, respectively. Sensitivity was 92% for 25 resected liver specimens from nine patients with all parenchymal margins grossly negative for disease. Four multifocal lesions were identified with two resected solely by ICG-avidity.

Conclusions: ICG is a sensitive adjunct for identifying local and metastatic hepatoblastoma, including lesions not visualized on preoperative imaging, and delineating margins during liver resection. False positives limit specificity; however, there were no adverse outcomes from additional resections. We noted that thoracoscopic surgery can be completed safely in patients with less significant disease burden, and conversion to thoracotomy, if necessary, is straightforward.
Type: video · 1 min · posted 2026-01-23 Canonical: https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416 ## Chapters - [0:00](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=0) ICG fluorescence imaging in hepatoblastoma surgery ## Statements - "This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatoblastoma" — Sophia Schermerhorn (clinical) [0:12](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=12) - "ICG was highly sensitive for detecting hepatoblastoma, about 90%" — Sophia Schermerhorn (clinical) [0:22](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=22) - "In a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging" — Sophia Schermerhorn (clinical) [0:27](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=27) - "Specificity was lower than sensitivity with false positives" — Sophia Schermerhorn (clinical) [0:39](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=39) - "False positives often represented vascular changes or inflammation" — Sophia Schermerhorn (clinical) [0:43](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=43) - "There were no adverse outcomes associated with any of the additional resections guided by ICG" — Sophia Schermerhorn (clinical) [0:46](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=46) - "ICG was effective in both open and minimally invasive surgery" — Sophia Schermerhorn (clinical) [0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50) - "ICG was effective in both relapse and primary disease" — Sophia Schermerhorn (clinical) [0:50](https://library.globalcastmd.com/watch/indocyanine-green-is-a-sensitive-adjunct-in-the-identification-and-surgical-management-of-local-and-metastatic-hepatoblastoma-11416?t=50) ## Transcript 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. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai