Differentiation of Benign Versus Malignant Pulmonary Nodules Using Near Infrared Fluorescence Imaging
Nicholas Hess, Olugbenga Okusanya, Neil Christie, Rajeev Dhupar, Arjun Pennathur, James Luketich, Inderpal Sarkaria.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
OBJECTIVE: The purpose of this study was to investigate the fluorescence retention of benign and malignant pulmonary nodules after administration of indocyanine green and interval imaging with near infrared fluorescence imaging (NIFI) at time of pulmonary resection. We hypothesize that benign and malignant lesions would express differential fluorescence expression.
METHODS: Enrolled patients underwent indocyanine green infusion one day prior to surgical removal of pulmonary nodule. Intraoperatively, all nodules were examined under normal white lighting and using NIFI technology both prior and after surgical resection, and rated on fluorescence intensity. All nodules were subsequently reviewed by pathologist for histologic diagnosis.
RESULTS: Thirty-one patients underwent resection for pulmonary nodules, 7 benign and 24 malignant. Benign nodules displayed an in situ fluorescence rate of 28.9% whereas malignant lesions displayed in situ fluorescence rate of 66.7%. The presence in situ fluorescence in predicting malignancy was 66.7% with a specificity of 71.4%. The positive and negative predictive values for the presence of malignancy were 88.9% and 38.4%, respectively.
CONCLUSIONS: Intraoperative use of NIFI technology with indocyanine green is feasible. While the technology did not significantly aid in visualization of either poorly or non-visualized pulmonary nodules during time of pulmonary resection, it did aid in differentiation of benign versus malignant disease.
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