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Intraoperative near‐infrared fluorescence guided surgery using indocyanine green (ICG) for the resection of sarcomas may reduce the positive margin rate: An extended case series

Lookup NU author(s): Marcus BrookesORCiD, Dr Corey ChanORCiD, Dr Fabio Nicoli, Tom Beckingsale, Daniel Saleh, Dr Petra Dildey, Mani Ragbir, Dr Kenneth RankinORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021 by the authors. Licensee MDPI, Basel, Switzerland.Background: Sarcomas are rare, aggressive cancers which can occur in any region of the body. Surgery is usually the cornerstone of curative treatment, with negative surgical margins associated with decreased local recurrence and improved overall survival. Indocyanine green (ICG) is a fluorescent dye which accumulates in sarcoma tissue and can be imaged intraoperatively using handheld near‐infrared (NIR) cameras, theoretically helping guide the surgeon’s resection margins. Methods: Patients operated on between 20 February 2019 and 20 October 2021 for intermediate to high grade sarcomas at our centres received either conventional surgery, or were administered ICG pre‐operatively followed by intra‐operative NIR fluorescence guidance during the procedure. Dif-ferences between the unexpected positive margin rates were compared. Results: 115 suitable patients were identified, of which 39 received ICG + NIR fluorescence guided surgery, and 76 received conventional surgery. Of the patients given ICG, 37/39 tumours fluoresced, and surgeons felt the procedure was guided by the intra‐operative images in 11 cases. Patients receiving ICG had a lower unexpected positive margin rate (5.1% vs. 25.0%, p = 0.01). Conclusions: The use of NIR fluorescence cameras in combination with ICG may reduce the unexpected positive margin rate for high grade sarcomas. A prospective, multi‐centre randomised control trial is now needed to validate these re-sults.

Publication metadata

Author(s): Brookes MJ, Chan CD, Nicoli F, Crowley TP, Ghosh KM, Beckingsale T, Saleh D, Dildey P, Gupta S, Ragbir M, Rankin KS

Publication type: Article

Publication status: Published

Journal: Cancers

Year: 2021

Volume: 13

Issue: 24

Online publication date: 14/12/2021

Acceptance date: 11/12/2021

Date deposited: 21/01/2022

ISSN (electronic): 2072-6694

Publisher: MDPI


DOI: 10.3390/cancers13246284


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