Identification of extrahepatic metastasis of hepatocellular carcinoma using indocyanine green fluorescence imaging

Background/purpose: Intraoperative fluorescence imaging with indocyanine green (ICG) plays a significant role in the identification of hepatocellular carcinoma (HCC) during Hepatectomy. Despite that, few researchers have reported using ICG fluorescence imaging to detect extrahepatic metastases. Herein, we report the successful application of ICG fluorescence imaging in the detection of extrahepatic metastatic lesions from primary liver cancer. Methods: In two HCC patients, a near-infrared fluorescence imaging system was used to intraoperatively examine the abdominal cavity for implantation metastasis after hepatectomy of the primary tumor, following pre-operative intravenous infusion with ICG. Results: In the first case, the abdominal cavity implantation metastasis exhibited intense fluorescence and clear boundaries of tumors during abdominal tumor resection, and there was no fluorescence in the resection margin. In the second case, a new lesion that was not detected by preoperative imaging examination was found in the omentum by ICG fluorescence imaging. Intraoperative rapid freezing pathology showed that it was an adenocarcinoma. Accordingly, we revised the tumor staging. Conclusion: ICG fluorescence imaging can not only detect intrahepatic metastases, but also extrahepatic metastases. Furthermore, it can help surgeons correct tumor staging during surgery.