Department of Biomedical Science, College of Medicine, Korea University, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, College of Medicine, Korea University, Seoul, Korea.
Ann Surg. 2021 May 1;273(5):989-996. doi: 10.1097/SLA.0000000000003300.
This study was conducted to develop a fluorescent iodized emulsion comprising indocyanine green (ICG) solution and lipiodol (ethiodized oil) and evaluate its feasibility for use in a clinical setting.
ICG use for the preoperative localization of pulmonary nodules is limited in terms of penetration depth and diffusion.
First, fluorescent microscopy was used to investigate the distribution of ICG-lipiodol emulsions prepared using different methods. The emulsions were injected in 15 lung lobes of 3 rabbits under computed tomography fluoroscopy guidance; evaluation with imaging and radiography was conducted after thoracotomy. Subsequently, the emulsions were used to preoperatively localize 29 pulmonary nodules in 24 human subjects, and wedge resections were performed using fluorescent imaging and C-arm fluoroscopy.
The optimal emulsion of 10% ICG and 90% lipiodol mixed through 90 passages had even distribution and the highest signal intensity under fluorescent microscopy; it also had the best consistency in the rabbit lungs, which persisted for 24 hours at the injection site. In human subjects, the mean diameter of pulmonary nodules was 0.9 ± 0.4 cm, and depth from the pleura was 1.2 ± 0.8 cm. All emulsion types injected were well localized around the target nodules without any side effects or procedure-related complications. Wedge resection with minimally invasive approach was successful in all pulmonary nodules with a free resection margin.
A fluorescent iodized emulsion prepared by mixing ICG with lipiodol enabled accurate localization and resection of pulmonary nodules.
本研究旨在开发一种包含吲哚菁绿（ICG）溶液和碘油（乙碘油）的荧光碘化乳剂，并评估其在临床应用中的可行性。
ICG 用于术前肺结节定位的局限性在于穿透深度和扩散。
首先，荧光显微镜用于研究不同方法制备的 ICG-碘油乳剂的分布情况。在 CT 透视引导下，将乳剂注入 3 只兔的 15 个肺叶中；开胸后进行影像学和放射学评估。随后，将乳剂用于 24 名患者的 29 个肺结节的术前定位，并使用荧光成像和 C 臂透视进行楔形切除术。
在荧光显微镜下，经 90 次传递混合的 10%ICG 和 90%碘油的最佳乳剂分布均匀，信号强度最高；在兔肺中也具有最佳的一致性，在注射部位持续 24 小时。在患者中，肺结节的平均直径为 0.9 ± 0.4 cm，距胸膜的深度为 1.2 ± 0.8 cm。所有注射的乳剂类型均能很好地定位在目标结节周围，无任何副作用或与操作相关的并发症。所有肺结节均采用微创方法进行楔形切除术，切缘无肿瘤。
ICG 与碘油混合制备的荧光碘化乳剂可实现肺结节的准确定位和切除。
