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Akihiro Ohsumi



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    P2.17 - Treatment of Early Stage/Localized Disease (ID 189)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.17-26 - Indocyanine Green Virtual Assisted Lung Mapping (ICG-VAL-MAP): Anyone Can Perform a Successful Preoperative Marking for a Small Lung Nodule (Now Available) (ID 2320)

      10:15 - 18:15  |  Author(s): Akihiro Ohsumi

      • Abstract
      • Slides

      Background

      As a preoperative marking of small pulmonary nodules, we developed Virtual Assisted Lung Mapping (VAL-MAP), which is consisted of preoperative simulation using three-dimensional CT images and transbronchial dye marking using indigocarmine (IC). Between 2012 and 2016, we performed VAL-MAP in more than 200 cases in a single institution; however, we sometimes came across a situation, in which an identification of marked IC was difficult at post-marking CT and/or during surgery. Herein, we have developed a new VAL-MAP (ICG-VAL-MAP) using indocyanine green (ICG) and contrast agent. The purpose of this study was to prospectively evaluate the visibility of newly-developed ICG-VAL-MAP in an identification of ICG at post-marking CT as well as during surgery.

      Method

      Between January in 2017 and February in 2019, we performed ICG-VAL-MAP, using ICG and contrast agent in addition to IC as a marker for preoperative nodule identification, in 88 patients at our institution. Preoperative marking was performed on the same day as surgery or 1 day before surgery. During surgery, fluorescence endoscope system was used for identification of marked ICG.

      Result

      Targeted lesions were 105 nodules with the diameter ranging from 2 to 38 mm (median 8 mm). The depth of the lesion from the pleural surface ranged from 0 to 49 mm (median 8 mm). Total marking numbers were 208 (IC: 99, ICG: 109). At post-marking CT, IC was easily identified in 78 markings (78%), difficult to be identified in 10 markings (10%), and unable to be identified in 11 markings (11%). On the other hand, ICG was easily identified in all markings at post-marking CT. During surgery, IC was easily identified in 74 markings (74%), slightly identified in 4 markings (4%), and unable to be identified in 21 markings (21%). On the other hand, ICG was easily identified in 108 markings (99%) during surgery. Only in 1 case, ICG marking was accidentally placed far from a pleural surface, but ICG was slightly identified in a collapsed lung during surgery. In summary, ICG was significantly easily identified than IC during surgery (P<0.0001) as well as at post-marking CT (P=0.0002). There were no significant perioperative complications related to ICG-VAL-MAP. All nodules were identified intraoperatively and an appropriate surgical resection was conducted in each patient. In details, 53 wedge resections, 48 segmentectomies and 2 lobectomies were performed. Furthermore, all nodules were diagnosed pathologically (74 primary lung cancer, 24 metastatic lung cancer, and 7 benign nodule).

      Conclusion

      We confirmed that ICG-VAL-MAP was a novel and promising technique with better visibility than conventional VAL-MAP for the complete resection of small pulmonary nodules.

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