Usefulness of intraoperative diagnosis of hepatic tumors located at the liver surface and hepatic segmental visualization using indocyanine green-photodynamic eye imaging

Eur J Surg Oncol. 2015 Feb;41(2):257-64. doi: 10.1016/j.ejso.2014.09.008. Epub 2014 Oct 18.


Background: To improve the diagnostic accuracy for hepatic tumors on the liver surface, we investigated the usefulness of an indocyanine green-photodynamic eye (ICG-PDE) system by comparison with Sonazoid intraoperative ultrasonography (IOUS) in 117 patients. Hepatic segmentation by ICG-PDE was also evaluated.

Methods: ICG was administered preoperatively for functional testing and images of the tumor were observed during hepatectomy using a PDE camera. ICG was injected into portal veins to determine hepatic segmentation.

Results: Accurate diagnosis of liver tumors was achieved with ICG-PDE in 75% of patients, lower than with IOUS (94%). False-positive and false-negative diagnosis rates for ICG-PDE were 24% and 9%, respectively. New small HCCs were detected in 3 patients. The ICG fluorescent pattern in tumors was strong staining in 41%, weak staining in 13%, rim staining in 20% and no staining in 26%. Hepatocellular carcinoma predominantly showed strong staining (61%), while rim staining predominated in cholangiocellular carcinoma (60%) and liver metastasis (55%). Hepatic segmental staining was performed in 28 patients, proving successful in 89%.

Conclusion: ICG-PDE is a useful tool for detecting the precise tumor location at the liver surface, identifying new small tumors, and determining liver segmentation for liver resection.

Keywords: Hepatectomy; Indocyanine green; Liver tumor; Navigation; Photodynamic eye.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / diagnosis*
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / surgery
  • Bile Ducts, Intrahepatic*
  • Carcinoma, Hepatocellular / diagnosis*
  • Carcinoma, Hepatocellular / surgery
  • Cholangiocarcinoma / diagnosis*
  • Cholangiocarcinoma / secondary
  • Cholangiocarcinoma / surgery
  • Colorectal Neoplasms / pathology*
  • Contrast Media
  • False Negative Reactions
  • False Positive Reactions
  • Feasibility Studies
  • Female
  • Ferric Compounds
  • Fluorescent Dyes*
  • Gallbladder Neoplasms / pathology*
  • Hepatectomy / methods
  • Humans
  • Indocyanine Green*
  • Intraoperative Care
  • Iron
  • Liver Neoplasms / diagnosis*
  • Liver Neoplasms / secondary
  • Liver Neoplasms / surgery
  • Male
  • Middle Aged
  • Neuroendocrine Tumors / pathology*
  • Oxides
  • Ultrasonography


  • Contrast Media
  • Ferric Compounds
  • Fluorescent Dyes
  • Oxides
  • Sonazoid
  • Iron
  • Indocyanine Green