Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Laboratory scoring system to predict hepatic indocyanine green clearance ability during fluorescence imaging-guided laparoscopic hepatectomy
Zhen-Rong Chen, Qing-Teng Zeng, Ning Shi, Hong-Wei Han, Zhi-Hong Chen, Yi-Ping Zou, Yuan-Peng Zhang, Fan Wu, Lian-Qun Xu, Hao-Sheng Jin
Zhen-Rong Chen, Ning Shi, Yuan-Peng Zhang, Fan Wu, Hao-Sheng Jin, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong Province, China
Zhen-Rong Chen, Ning Shi, Hong-Wei Han, Zhi-Hong Chen, Yi-Ping Zou, Yuan-Peng Zhang, Fan Wu, Lian-Qun Xu, Hao-Sheng Jin, Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, Guangdong Province, China
Qing-Teng Zeng, Department of Hepatobiliary Surgery, Shenzhen Hospital of Traditional Chinese Medicine, Shenzhen 518000, Guangdong Province, China
Zhi-Hong Chen, Yi-Ping Zou, Medical College, Shantou University, Shantou 515000, Guangdong Province, China
Author contributions: Chen ZR, Zeng QT, and Shi N contributed equally to this study. Chen ZR, Zeng QT, and Han HW designed the study; Chen ZR and Han HW collected the clinically relevant data, obtained, outlined, and measured the fluorescence intensity values of the intraoperative images; Chen ZH and Zou YP were responsible for the statistical analysis; Chen ZH, Zou YP, and Shi N drafted the manuscript; and all authors revised the manuscript; Shi N and Jin HS were responsible for critical review of the research and articles.
Supported by the National Key Clinical Specialty Construction Project of China, No. 2022YW030009.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of Guangdong Provincial People’s Hospital.
Clinical trial registration statement: This study was registered in the Chinese Clinical Trials Registry (
https://www.chictr.org.cn/), registration number: ChiCTR2200056978.
Informed consent statement: Informed consent was obtained from each enrolled patient before entering this study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hao-Sheng Jin, PhD, Professor, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510000, Guangdong Province, China. kinghaos@126.com
Received: February 13, 2023
Peer-review started: February 13, 2023
First decision: March 28, 2023
Revised: April 11, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: July 27, 2023
BACKGROUND
Indocyanine green (ICG) fluorescence played an important role in tumor localization and margin delineation in hepatobiliary surgery. However, the preoperative regimen of ICG administration was still controversial. Factors associated with tumor fluorescence staining effect were unclear.
AIM
To investigate the preoperative laboratory indexes corelated with ICG fluorescence staining effect and establish a novel laboratory scoring system to screen specifical patients who need ICG dose adjustment.
METHODS
To investigate the predictive indicators of ICG fluorescence characteristics in patients undergoing laparoscopic hepatectomy from January 2018 to January 2021 were included. Blood laboratory tests were completed within 1 wk before surgery. All patients received 5 mg ICG injection 24 h before surgery for preliminary tumor imaging. ImageJ software was used to measure the fluorescence intensity values of regions of interest. Correlation analysis was used to identify risk factors. A laboratory risk model was established to identify individuals at high risk for high liver background fluorescence.
RESULTS
There were 110 patients who were enrolled in this study from January 2019 to January 2021. The mean values of fluorescence intensity of liver background (FI-LB), fluorescence intensity of gallbladder, and fluorescence intensity of target area were 18.87 ± 17.06, 54.84 ± 33.29, and 68.56 ± 36.11, respectively. The receiver operating characteristic (ROC) curve showed that FI-LB was a good indicator for liver clearance ability [area under the ROC curve (AUC) = 0.984]. Correlation analysis found pre-operative aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase, adenosine deaminase, and lactate dehydrogenase were positively associated with FI-LB and red blood cell, cholinesterase, and were negatively associated with FI-LB. Total laboratory risk score (TLRS) was calculated according to ROC curve (AUC = 0.848, sensitivity = 0.773, specificity = 0.885). When TLRS was greater than 6.5, the liver clearance ability of ICG was considered as poor.
CONCLUSION
Preoperative laboratory blood indicators can predict hepatic ICG clearance ability. Surgeons can adjust the dose and timing of ICG preoperatively to achieve better liver fluorescent staining.
Core Tip: Indocyanine green (ICG) fluorescence plays an important role in tumor localization and edge delineation in hepatobiliary surgery. However, the preoperative medication scheme of ICG is still controversial. Factors related to the effect of tumor fluorescence staining are still unclear. The purpose of this study is to investigate the preoperative laboratory indicators related to the effect of ICG fluorescence staining, and establish a new risk scoring system to screen specific patients who need to adjust the ICG dose. This scoring system will provide a new method and idea, making it possible to individualize the usage and dosage of ICG staining.
