Indocyanine green-guided nephron-sparing surgery for pediatric renal tumors

Background: Indocyanine green (ICG), a water-soluble tricarbocyanine fluorophore, is being increasingly used for tumor localization based on its passive intra-tumoral accumulation due to enhanced permeabil-ity and retention in tumor tissue. Therefore, we hypothesized that ICG can provide contrast to facilitate accurate, real-time recognition of renal tumors at the time of nephron-sparing surgery in children.Methods: This retrospective study examined the feasibility of ICG in guiding nephron-sparing surgery for pediatric renal tumors.Results: We reviewed the medical records of 8 pediatric patients with renal tumors in 12 kidneys. Intra-operative localization of tumor with near infrared guidance was successful in all 12 kidneys. However, we consistently found an inverse pattern of near infrared signal in which the normal kidney demonstrated increased fluorescent signal relative to the kidney tumor.Conclusions: Fluorescence-guided renal tumor delineation is unique because it has an inverse pattern of near infrared signal in which the normal kidney demonstrates increased signal relative to the adjacent tumor. Nevertheless fluorescence-guided distinguishing of renal tumor from surrounding normal kidney is feasible.(c) 2021 Elsevier Inc. All rights reserved.

Automated summary

ICG can successfully guide intra-operative localization of renal tumors in children using near infrared light, with a unique inverse pattern of signal where normal kidney shows higher fluorescence than the tumor. Fluorescence-guided distinction between renal tumor and surrounding normal kidney is feasible.