Scholarlink

<p>Indocyanine green (ICG) positive staining aids tumor localization in robotic hepatectomy; however, ICG dose and timing remain heterogeneous. We sought to optimize preoperative dosing using total liver volume (TLV)-normalized doses and an image-derived tumor-to-normal fluorescence ratio (TNR), and relate TNR to intraoperative tumor identification.&#xa0;This single-center observational study analyzed 26 consecutive, surface-adjacent hepatic lesions that underwent robotic hepatectomy. ICG was administered intravenously at noon on day − 1. Firefly<sup>®</sup> images were captured; a prespecified FIJI pipeline extracted the green channel and computed TNR as mean tumor region of interest (ROI) intensity/mean liver ROI intensity. Quadratic regression modeled TNR against TLV-normalized dose (mg/L), adjusting for ICG elimination rate constant and tumor diameter; parametric bootstrap (2,000) yielded the optimum and 95% confidence interval (CI). Receiver operator characteristic analysis assessed identification using prespecified TNR ≥ 2.0.&#xa0;Fluorescence identified 23/26 lesions (88%). The median TNRs were 2.60 (interquartile range 2.28–3.01) and 1.75 (1.38–1.80) in identified and non-identified tumors, respectively (<i>p</i> = 0.005). TLV-normalized modeling exhibited an inverted-U dose–response (quadratic <i>p</i> = 0.006); the optimum was 6.80&#xa0;mg/L (95% CI 5.80–8.12). The mg/kg optimum was 0.10&#xa0;mg/kg, and model fit favored TLV over mg/kg (difference in corrected Akaike’s information criterion, 4.9). TNR discriminated identification well (area under the curve, 0.96) at TNR ≥ 2.0.&#xa0;A single day − 1 dose targeting 6.8&#xa0;mg/L by TLV maximizes fluorescence contrast; TNR ≥ 2.0 is a practical visibility benchmark. A simple bedside rule—dose (mg) = 6.8 × TLV (L)—offers a patient- and organ-informed protocol for prospective validation and multicenter standardization.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Optimizing indocyanine green positive staining with total liver volume-normalized dosing in robotic hepatectomy: an image-based analysis

  • 期刊论文

  • 发表日期：

    2025年11月17日

查看全文
  • Yuta Ushida,
  • Gen Sugawara,
  • Yoriko Yamashita,
  • Masaya Inoue

摘要

Indocyanine green (ICG) positive staining aids tumor localization in robotic hepatectomy; however, ICG dose and timing remain heterogeneous. We sought to optimize preoperative dosing using total liver volume (TLV)-normalized doses and an image-derived tumor-to-normal fluorescence ratio (TNR), and relate TNR to intraoperative tumor identification. This single-center observational study analyzed 26 consecutive, surface-adjacent hepatic lesions that underwent robotic hepatectomy. ICG was administered intravenously at noon on day − 1. Firefly® images were captured; a prespecified FIJI pipeline extracted the green channel and computed TNR as mean tumor region of interest (ROI) intensity/mean liver ROI intensity. Quadratic regression modeled TNR against TLV-normalized dose (mg/L), adjusting for ICG elimination rate constant and tumor diameter; parametric bootstrap (2,000) yielded the optimum and 95% confidence interval (CI). Receiver operator characteristic analysis assessed identification using prespecified TNR ≥ 2.0. Fluorescence identified 23/26 lesions (88%). The median TNRs were 2.60 (interquartile range 2.28–3.01) and 1.75 (1.38–1.80) in identified and non-identified tumors, respectively (p = 0.005). TLV-normalized modeling exhibited an inverted-U dose–response (quadratic p = 0.006); the optimum was 6.80 mg/L (95% CI 5.80–8.12). The mg/kg optimum was 0.10 mg/kg, and model fit favored TLV over mg/kg (difference in corrected Akaike’s information criterion, 4.9). TNR discriminated identification well (area under the curve, 0.96) at TNR ≥ 2.0. A single day − 1 dose targeting 6.8 mg/L by TLV maximizes fluorescence contrast; TNR ≥ 2.0 is a practical visibility benchmark. A simple bedside rule—dose (mg) = 6.8 × TLV (L)—offers a patient- and organ-informed protocol for prospective validation and multicenter standardization.