Intraoperative localization of insulinoma and normal pancreas using invisible near-infrared fluorescent light

Ann Surg Oncol. 2010 Apr;17(4):1094-100. doi: 10.1245/s10434-009-0868-8. Epub 2009 Dec 22.


Background: Neuroendocrine tumors of the pancreas, such as insulinoma, are difficult to localize, and complete resection is essential for cure. Our hypothesis is that a near-infrared (NIR) fluorophore exhibiting uptake in insulinoma could provide high-sensitivity detection intraoperatively.

Materials and methods: The optical properties of methylene blue (MB) were measured in vitro in 100% serum at 37 degrees C and in vivo after tissue uptake. MB was injected as a rapid intravenous bolus at doses ranging from 0.25 to 2 mg/kg into wildtype rats and pigs, and into insulinoma-bearing transgenic mice. The FLARE imaging system was used to acquire color video and NIR fluorescence images simultaneously and in real-time. The signal-to-background ratios (SBR) of tissues and tumors were quantified using FLARE software.

Results: When appropriately diluted, MB exhibits moderate NIR fluorescence emission peaking at 688 nm. At doses > or =1 mg/kg, certain normal tissues, such as pancreas, accumulate MB and remain NIR fluorescent for up to 1 h with an SBR > or = 1.6. MB spectral properties are maintained after uptake into tissue. Interestingly, insulinoma exhibits even higher MB signal than normal pancreas, resulting in insulinoma-to-pancreas ratios of 3.7 and insulinoma-to-muscle ratios of 16.2. MB permitted high-sensitivity, real-time localization of primary, multicentric, and metastatic insulinoma and permitted differentiation among tumor, normal pancreas, and other abdominal structures.

Conclusion: A single intravenous injection of a clinically available, commonly used NIR fluorophore provides prolonged intraoperative localization of normal pancreas and insulinoma using invisible NIR fluorescent light.

Keywords: Intraoperative Imaging; Methylene Blue; Near-Infrared Fluorescence; Neuroendocrine Tumors; Pancreas.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Female
  • Fluorescent Dyes
  • Infrared Rays*
  • Injections, Intravenous
  • Insulinoma / diagnosis*
  • Insulinoma / surgery
  • Intraoperative Period
  • Male
  • Methylene Blue
  • Mice
  • Mice, Inbred NOD
  • Mice, Transgenic
  • Pancreatic Neoplasms / diagnosis*
  • Pancreatic Neoplasms / surgery
  • Rats
  • Rats, Sprague-Dawley
  • Spectroscopy, Near-Infrared*
  • Swine


  • Fluorescent Dyes
  • Methylene Blue