Inhalational Indocyanine Green to 

Visualize Lung Tumors—Defining the Resection Margins

During surgical treatment of non-small cell lung cancer (NSCLC), the lobectomy or greater resection of lung is the standard surgical treatment regardless of the tumor location or size, however it is associated with high complication rate especially in high-risk surgical patients. Limited resection is currently considered the treatment of choice in compromised patients who cannot tolerate lobectomy and even in non-compromised patients with small peripheral NSCLC. In case of the limited resection, acquisition of enough surgical margin of tumor is the most important to control the local recurrence. Since Ishizawa, et al. reported the intraoperative visualization of both colorectal hepatic metastases and hepatocellular carcinoma (HCC) by using near-infrared (NIR) fluorescence imaging after the intravenous injection of indocyanine green (ICG), this intraoperative imaging technique have been utilized in several type of cancers. However, this technique is a non-tumor-specific technique requiring large amounts of ICG injection, and due to the non-organ-specific distribution needs to wait until the ICG is cleared by circulation. In this study, we developed the novel technique for intraoperative defining the lung cancer margin by inhalation of ICG under fluorescent imaging system. This technique could provide 2 times higher tumor margin detection efficiency with 20 times lower dose comparing to the conventional intravenous injection method. In addition, inhalation ICG was expected to be well suited for clinical research, because ICG inhalation can be performed before or during surgery as well as detecting tumor margin immediately after injection. This study may provide not only more accurate resection of lung cancer, but also better patient’s safety during surgery.

[Reference] Yu Hua Quan et al., “Evaluation of Intraoperative Near-Infrared Fluorescence Visualization of the Lung Tumor Margin With Indocyanine Green Inhalation” JAMA Surgery, doi: 10.1001/jamasurg.2020.1314. Online ahead of print.

[Main Author] Yu Hua Quan (Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea, Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University), Ji-Ho Park (Department of Bio and Brain Engineering and KAIST Institute for Health Science and Technology, Korea Advanced Institute of Science and Technology), Hyun Koo Kim(Department of Biomedical Sciences, College of Medicine, Korea University, Seoul, Republic of Korea, Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University)

* Contact : Professor Hyun Koo Kim(kimhyunkoo@korea.ac.kr), Professor Ji-Ho Park (jihopark@kaist.ac.kr)