Intraoperative Tumor Margin Identification With ICG Dye Imaging

If you are present for a preoperative clinic visit the day before your surgery, ICG may

be administered via injection. Otherwise, ICG will be administered in the preoperative

unit via IV injection at the time of presentation approximately 4 hours before your

surgery. You will be monitored during and after ICG dosing.

During surgery ICG fluorescence using a near-infrared imager will be performed at the

time of and immediately following primary tumor resection. The imager will evaluate the

primary tumor to ensure appropriate tumor fluorescence. Once the primary resection is

complete and the surgeon believes that he/she has achieved negative or planned positive

margins, fluorescence measurements of the tumor bed will be performed. If areas of

positive signal remain, these areas will be resected if possible and sent to pathology

for histologic evaluation. It will be recorded if the surgeon perceived negative margins

but the device detected positive margins.

Tumor specimens and residual fluorescence positive samples will be evaluated using fresh

frozen and permanent histology. Permanent samples will be evaluated for tumor and local

fluorescence using confocal microscopy with an ICG cube. Positive fluorescence signal and

its correspondence with neoplasm will be noted, a will tumor that does not fluoresce.

Tissue being removed is 1-2 mm from non-structurally important tissue that either has or

does not have signal positivity for additional pathologic assessment. It should have no

impact on patient outcome, does not represent intervention on sensitive areas (such as

neurovascular structures), and can further be used as potential margin around the tumor.