Tumor Lesion Detection in Patients with Cervical Cancer by Indocyanine Green Near-Infrared Imaging

Abstract

Abstract Purpose：To investigate the feasibility and accuracy of near-infrared fluorescence (NIRF) imaging for detecting the extent of tumor invasion in cervical cancer using indocyanine green (ICG).Methods: We enrolled 51 patients who were diagnosed with cervical cancer with FIGO stage IB1-IIA2 disease. Patients were administered indocyanine green (ICG) at a dose of 5 mg/kg 24 hours prior to surgery. A customized near-infrared fluorescence (NIRF) imaging system was used to identify the extension of tumor invasion when radical hysterectomy specimens were harvested. The relationship between tumor fluorescence intensity and clinicopathological characteristics was analyzed. Results: Three patients were without residual tumors after cervical conization, and tumor lesions were identified by NIRF imaging in all the remaining 48 patients. The results of NIRF imaging were in agreement with the postoperative pathological findings in 95.8% of the patients with stromal invasion, 100% of those with surgical margin invasion, 100% of those with parametrial tumor involvement, and 100% of patients with uterine corpus invasion. The mean signal-to-background ratio (SBR) of the cervical tumors was 2.91±1.64, and the SBR was independent of clinicopathological characteristics. Fluorescence microscopy confirmed that ICG fluorescence was present in the tumor nests.Conclusions: NIRF imaging enables objective, accurate and safe identification of tumor invasion during cervical cancer surgery.Clinical Trial Registration: ClinicalTrials.gov NCT04224467.