Table 3.
Operative details and outcomes from studies that used CT-guided Indocyanine Green localization.
| Study | Patients | ICG dose | Other localization technique | Duration of localization, min, median [range] | Timing between localization and Lung Resection | Duration of lung resection, min, median [IQR] | Total time, min, median (IQR) | Radiation Exposure | Successful Localization | Reasons for Localization Failure | Complications | Histology |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hsu et al. (20) | 46 | 0.3 ml of 0.125 mg/mL | No | 10.0 (7.3–15.0) | N/R | 55 (40–75) | 163 (135–190) | N/R | 45/46 (90%) | N/R | 3 Persistent a/l >3 d (6.5%), 1 chylothorax (2%) | Invasive Adenocarcinoma: 7, Metastases: 8, Adenocarcinoma in situ: 17, Minimally invasive adenocarcinoma: 13 Benign: 13 |
| Wu et al. (21) | 32 | 0.3–1 ml of 2.5 mg/ml | No | 8.3 (6–15) | 40–60 min | 45.3 (38–62)for Wedge & 65 (50–120) for lobectomy | N/R | N/R | 33/36 (91.7%) | Diffuse thoracic images: 2, Images not developed: 1 | 3 dyspnoea & chest pain post-localization (9.4%), 1 post-op AF (reverted) (3%) | All R0 36/36, 28 malignant, 8 Benign, Non-small cell lung cancer: 9, Carcinoma in situ: 5, Atypical hyperplasia: 12, Organizing pneumonia: 5, Metastases: 2, Lymphoid tissue: 2 |
| Ding et al. (22) | 65 | 0.03 ml of 25 mg of ICG mixed with 50 ml of Iopamiro | Iopamiro (Iopamidol) | 24.52 ± 3.43 | From localization to VATS within 60 min | N/R | N/R | N/R | 85/85 (100%) | N/A | 18 pneumothorax (27.7%), 5 lung parenchymal hemorrhage (7.7%) (no drain required) | All R0, 64 Malignant (75%), 12 Benign, Adenocarcinoma in situ: 22, Minimally invasive adenocarcinoma: 23, Invasive adenocarcinoma: 19, Hamartoma: 1, Benign: 12, Granuloma: 1, atypical adenomatous hyperplasia primary (n = 5) |
| Li et al. (23) | 471 | 0.4 ml of ICG (2.5 mg/mL) + 0.8 ml N/S | No | 18.0 (10–47) | within 24 h | N/R | N/R | Average Radiation: 281.5 mGy | 415/512 (81.1%) | Diffusion of ICG in the thorax | 32 pulmonary hemorrhage (6.8%), 28 pneumothorax (5.9%), 2 hemoptysis (0.4%), 2 pleural reaction (0.4%) (no drain required) | All R0, Benign: 49, Atypical adenomatous hyperplasia: 26, Adenocarcinoma in situ: 28, Minimally invasive adenocarcinoma: 289, Invasive adenocarcinoma: 99, Small cell lung cancer: 1 |
| Zhang et al. (24) | 35 | 0.1–0.2 ml of 2.5 mg/ml | No | 28 (18–40) | After satisfactory injection of ICG, patients were sent directly to the operating room | Median 25 (16–30) | N/R | N/R | 32/35 (91.4%) | 1 insufficient ICG injection, 1 ICG leakage to the thoracic cavity, 1 deep lesion in the lung parenchyma requiring lobectomy | None | 33 adenocarcinomas (94.2%), 1 benign disease (2.9%), and 1 metastatic lung cancer from colon cancer (2.9%) |
| Li et al. (25) | 19 (6 ICG/lipoidol mixture only, 13 ICG/lipoidol mixture + Hook wire) | 0.2–0.4 ml mixture of ICG with lipiodol in 1 to 9 or 2 to 8 ratio | ICG/lipoidol mixture + spiral end hookwire (SOMATEXR Lung Marker System®, Somatex Medical Technologies GmbH, Germany) | Average 42.6 | 5 hrs after the localization | Average 73.4 min | N/R | N/R | 19/19 (100%) | N/A | All developed trace to mild <5% pneumothorax (no drain required), Some patients experienced wound pain and mild cough | lung adenocarcinomas (n = 13); minimal invasive adenocarcinoma (n = 1); atypical adenomatous hyperplasia (n = 1); adenocarcinoma in-situ (n = 1); interstitial fibrosis/scar (n = 3). |
| Chang et al. (26) | 175 | 0.3 ml of 2.5 mg/ml | No | 14.71 ± 6.02 | 13.67 ± 7.47 min | N/R | N/R | N/R | 172/175 (98.3%) | 1 ICG spealage. In the 3 cases that ICG was not visible there was erroneous injection of the ICG dye into the deep lung parenchyma | 6 small pneumothorax (3.4%) (no drain required), 1 persistent air leak >5 days (0.6%), 1 empyema (0.6%) | Malignant 111 (63.4%), Benign 64 (36.6%) |
| Nagai et al. (27) | 37 | 0.5 ml deployed into the lung parenchyma adjacent to the nodule, and then another 0.5 ml was injected while withdrawing the needle; thus, in total, 1 ml (12.5 mg/ml) | No | 19.4 min (12–41) | 102 min (IQR: 84–179). | N/R | N/R | N/R | 35/37 (94.6%) | 2 localization failures occurred owing to dye spreading and severe pleural adhesion | 3 mild pneumothorax (8.1%) (no drain required), 5 Cough (13.5%), 1 Mild Haemoptysis (2.7%) | All R0, 31 nodules were malignant (Adenocarcinoma: 20, Metastases: 11) and 6 were Benign |
| Ujiie et al. (28) | 20 | 100 to 150 μl of 0.125 mg/ml | Vortex microcoil | 35 (19–59) | Immediately after localization | 54 (28–84) | N/R | N/R | 18/20 with ICG (90%) (2/20 detected the microcoils with fluroscopy) | 1 Failed ICG case: nodule 1.0 cm in size was located 4.8 cm from the pleura, 1 failed ICG case due to unsuccessful lung deflation | None | All R0, Adenocarcinoma: 16, SCC: 1, Small Cell: 1, Focal perivascular lymphoid infiltrate: 1, Metastases: 1 |
| Zhong et al. (29) | 30 | 2.5 mg/ml using 25% human serum albumin with 100 to 150 ml of ICG | microcoil | Median 25 (19–49) | Immedately aftter microcoil position | 50 (42–80) | N/R | N/R | 42/42 (100%) | N/A | None | All R0 21 adenocarcinomas, 3 squamous cell carcinomas, 3 adenocarcinoma squamous cell carcinomas and 3 small cell carcinomas |
| Yan-Long Yang at al. (30) | 35 | ICG/iopamidol mixture 0.3–0.5 ml of ICG concentration 0.125 mg/ml | ICG/iopamidol mixture | within 90 minutes | N/R | N/R | N/R | N/R | 33/35 (94.3%) | N/R | 5 pneumothorax (14%) - no chest drain required | All R0 , atypical adenomatous hyperplasia: 1 adenocarcinoma in situ: 12, microinvasive adenocarcinoma: 7, infiltrating adenocarcinoma: 13, Metastases: 1, Benign: 1 |
| Yeasul Kim et al. (31) | 28 | 0.3 ml of 0.5 mg/ml emulsion of 10% ICG and 90% lipiodol | lipiodol mixture with ICG | 14.3 ± 3.1 min | 310.1 min (118–1882) | 168.7 ± 53.3 min | N/R | N/R | 28/28 (100%) | N/A | 1 mild pneumothorax (3.2%) (no drain required) Post-op: 5 AF 16.1%), 2 pneumonia (6.4%), 3 air leak (9.7%) | 100% Malignant 28 had adenocarcinoma and 3 squamous cell carcinoma |
| Anayama et al. (32) | 15 | 50–100 µl of ICG/iopamidol marking solution. Diluting ICG (2.5 mg/ml, 10 ml) 100-fold with iopamidol (Iopamiron 370). 1 ml Syringe was filled | ICG/iopamidol mixture | N/R | localization was performed on the day of the operation | N/R | N/R | N/R | 15/16 (93.8%) | 1 failed because of the development of a small secondary pneumothorax that occurred after the first VATS marking | 3 Small pneumothorax (20%) (no drain required) | N/R |
AF, Atrial fibrillation; a/l, air leak; CT, Computer Tomography; ICG, Indocyanine Green; IQR, Interquartile Range; mGy, milligray; N/A, Not Applicable; N/R, Not Reported; N/S, Normal Saline; SCC, Squamous Cell Carcinoma; VATS, Video-assisted thoracoscopic surgery.