Author of

• 20165

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  P1.16 - Surgery (ID 702)

  • Event: WCLC 2017
  • Type: Poster Session with Presenters Present
  • Track: Surgery
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)

  • 22814

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    P1.16-012 - Application of Fluorescent and Iodized Dual Marker for Pre-Operative Localization and Image-Guided Surgery of Pulmonary Nodule (ID 9204)

    09:30 - 09:30  |  Author(s): B.H. Choi
    • Abstract

    Background:
    This study evaluated the feasibility of pre-operative localization of pulmonary nodule using dual marker composed with indocyanine green (ICG) and lipiodol for minimal and accurate resection in video-assisted thoracoscopic surgery (VATS).
    
    Method:
    To minimize separation of two materials, we mixed with different frequency and ratio of ICG and lipiodol using a 3-way stopcock, and investigated their distribution with fluorescent microscope. Three rabbits were undergone thoracotomy after computed-tomography (CT) fluoroscopy-guidance injection of each 0.1 ml emulsions into different lobes of rabbit lung at 6, 12 or 24 hours. The localized lesions were evaluated by near-infrared optical imaging and radiograph. The 0.3 ml of emulsion was pre-operatively injected into 22 patients under CT fluoroscpy-guidance, and the localization was then evaluated during surgery by near-infrared imaging and mobile C-arm fluoroscopic x-ray. All freshly excised specimens were diagnosed by pathologic examination.
    
    Result:
    In in vitro, the separation time of ICG and lipiodol emulsion was delayed proportionally to mixing frequency and ratio. The emulsion mixed with 90 passages and 90% lipiodol was the least separated at 24 hours. On the rabbit lung, the optimal emulsion remained stably on injection site until 24 hours after injection. Pulmonary nodule localization using the optimal emulsion was performed successfully on the 22 patients without complications.
    
    Conclusion:
    This easy optimal method for pre-operative localization of pulmonary nodule was successfully established. The emulsion can be a useful marker to show the location of lesion to surgeons. However, ICG and lipiodol were not mixed perfectly and evenly. Therefore, there will be needed a future research to stabilize two materials completely.
    
    

  • 22820

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    P1.16-018 - Intraoperative Detection of Tumor Resection Margin via Inhalation of Fluorescent Imaging Agents (ID 9755)

    09:30 - 09:30  |  Author(s): B.H. Choi
    • Abstract

    Background:
    Near Infrared (NIR) fluorescent (Indocyanine green, ICG)-based EPR (enhanced permeability and retention) effects on identifying surgical margins are being used in lung cancer surgery. However, as ICG is equally likely to accumulate in tumors and inflamed tissue, this can cause false-positive results. In this study, we developed the novel method of Inhaled fluorescent based detection of intraoperative tumor resection margin by distinguishing cancerous tissue from normal tissue in mouse and rabbit lung cancer models.
    
    Method:
    ICG (1 mg/kg) was administered to healthy mice and mice with lung cancer via inhalation for 1h, and the lung distribution of ICG was investigated using a fluorescence imaging system. And, we established a computed tomography-guided VX2 lung cancer model in 6 rabbits. ICG was administered to these rabbits and resected tumor from lung cancer patients via nebulizer, and the lung cancer was resected under fluorescence imaging system after 1h. The resected tumor margins were investigated using confocal microscopy.
    
    Result:
    In normal mice, the inhaled ICG signal was significantly higher in lung compared to other organs (liver, brain, spleen, and kidneys), and this signal decreased over time. In metastatic lung cancer mouse models, the inhaled ICG was distributed only in normal tissues, except cancer. In the rabbit and resected cancer of human, the margin between cancer and normal tissue were distinguished clearly, and the tumor was successfully resected under ICFIS guidance in all 6 rabbits (Fig 3). Additionally, fluorescence and histological microscopy demonstrated that ICG was localized in normal lung tissue. The difference of fluorescent intensity between normal versus cancer tissue showed significantly higher in inhaled ICG Figure 1
    
    
    
    Conclusion:
    Fluorescent signal was dominantly observed in normal lung tissue comparing to cancer area after inhalation of ICG. The aerosolized ICG could provide better image information for intraoperative identification of resection margin during lung cancer surgery than the intravenous ICG injection.