Indocyanine Green Cannot Predict Malignancy in Partial Nephrectomy: Histopathologic Correlation with Fluorescence Pattern in 100 Patients

Wake Forest University Baptist Medical Center, Urology, Medical Center Blvd, Winston-Salem, North Carolina, United States, 27103, 336-716-5702, 336-716-5711
Journal of endourology / Endourological Society (Impact Factor: 2.1). 02/2013; 27(7). DOI: 10.1089/end.2012.0756
Source: PubMed

ABSTRACT INTRODUCTION: Indocyanine Green (ICG) is emerging as a potential adjunct to robotic partial nephrectomy by its ability to aide in the real-time identification of renal vasculature, renal masses, and the renal mass-parenchymal margin. The fluorescence patterns of renal masses have not been adequately described according to histology and it remains unknown if fluorescence pattern can reliably predict histology or malignancy. We therefore describe the ICG fluorescence pattern of our first 100 robotic partial nephrectomies and correlate with histology. METHODS: We reviewed our prospective robotic partial nephrectomy database and categorized fluoresce pattern as isofluoresent (same as surrounding parenchyma), hypofluorescent (less than surrounding parenchyma, but with uptake), or afluorescent (no visable uptake of dye). Descriptive statistics were applied. RESULTS: All 14 cystic lesions were afluorescent, and comprised 9 malignant and 5 benign masses. Eighty-six lesions were solid, of which 3 were isofluorescent including two clear cell and one translocation tumor. The remaining 83 solid lesions were hypoflurescent and included 65 malignant and 18 benign lesions. Clear cell was the most common histology of which 96% were hypofluorescent and 4% isofluorescent. In determining malignant vs. benign lesions, hypofluorescence had a positive predictive value of 87%, negative predictive value of 52%, sensitivity of 84% and specificity of 57%. CONCLUSIONS: A three grade classification of renal mass ICG fluorescence pattern is correlated with some histologic findings, but unable to reliably predict malignant versus benign lesions.

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