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Case Reports
. 2021 Sep 16:8:655805.
doi: 10.3389/fsurg.2021.655805. eCollection 2021.

Attempt of Real-Time Near-Infrared Fluorescence Imaging Using Indocyanine Green (ICG) in Radical Resection of Gallbladder Cancer: A Case Report

Yang Yu  1   2 , Lin Xiang  1   2 , Yuping Bai  1   2 , Ewetse Paul Maswikiti  1   2 , Baohong Gu  1   2 , Xuemei Li  1   2 , Haiyuan Li  1   2 , Peng Zheng  1   2 , Ying Zhang  3 , Hao Chen  1
Affiliations
Case Reports

Attempt of Real-Time Near-Infrared Fluorescence Imaging Using Indocyanine Green (ICG) in Radical Resection of Gallbladder Cancer: A Case Report

Yang Yu et al. Front Surg. .

Abstract

Surgery is the mainstay of treatment for resectable gallbladder cancer. Near-infrared fluorescence (NIRF) imaging using ICG is an innovation in laparoscopic surgery, which can provide real-time navigation during the whole operation. In this article, we present a 56-year older woman with gallbladder cancer, in which we evaluated the applicability of NIRF imaging using ICG for tumor and biliary tree visualization during the operative procedure of gallbladder cancer. The tumor and biliary tree were clearly visualized by utilizing a green fluorescence dye. The patient was successfully operated radical resection of gallbladder cancer under fluorescence laparoscope, without any complications. According to this case, the utilization of ICG based NIRF imaging is feasible and beneficial in identifying tumors and the biliary tree during radical resection. It can assist in the achievement of a negative margin and lymphatic clearance around the biliary tree. However, further studies are needed to corroborate the results of this case.

Keywords: case report; fluorescence laparoscope; gallbladder cancer; indocyanine green; near-infrared fluorescence.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Magnetic resonance imaging (MRI) findings of the patient. T2-weighted (A,B, coronal; C, axial) imaging showed low signal intensity as an irregular filling defect in the gallbladder fundus and long signal in segment IV of the near liver (arrow). DWI (D) showed a hyperintense signal, and ADC map (E) showed reduced diffusion (arrow). MRCP (F) showed gallbladder enlargement with local filling defect (arrow).
Figure 2
Figure 2
Visualization of the tumor and biliary tree under real-time NIRF imaging. (A,B) Pale green fluorescence detected in the extrahepatic biliary tree (arrow). (C) Green fluorescence accumulated into the gallbladder bed (arrow). (D) Residual green fluorescence observed after wedge liver resection (arrow). (E) Resected gallbladder and liver under the natural light. (F) Dense green fluorescence of the opened gallbladder under the NIFR imaging.
Figure 3
Figure 3
Histologic features in gallbladder adenocarcinoma and liver sections. (A, B) Stromal infiltration of gallbladder adenocarcinoma. (A) Atypical glands were observed in a low to moderately differentiated gallbladder adenocarcinoma (A, H&E, ×40). (B) Distorted glands invaded the muscularis propria layer of the gallbladder (B, H&E, ×100). (C,D) Vascular invasion in gallbladder adenocarcinoma. (C) part of the dysplastic glands were sieve-like with mucus (C, H&E, ×40). (D) Dysplastic glands invaded the vascular walls (D, H&E, ×100). (E,F) A large number of lymphocytes infiltrated in the portal area of the liver; milder hepatic steatosis was observed in some areas (E, H&E, ×40; F, H&E, ×100).
Figure 4
Figure 4
The timeline of patient information.
See this image and copyright information in PMC

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