Prospective comparison of near-infrared I and II fluorescence imaging for intraoperative navigation in pediatric hepatoblastoma resection.

BACKGROUND

Complete resection is critical for cure in hepatoblastoma (HB), but small, superficial, or deep lesions may be missed by conventional intraoperative assessment or near-infrared window I (NIR-I) fluorescence imaging. We prospectively evaluated the feasibility and comparative performance of indocyanine green (ICG)-based near-infrared window II (NIR-II) fluorescence imaging during pediatric hepatoblastoma resection.

METHODS

Fourteen children with HB were prospectively enrolled. All patients received preoperative ICG administration and underwent intraoperative paired NIR-I and NIR-II fluorescence imaging using a self-developed multispectral imaging system. In vivo and ex vivo fluorescence findings were correlated with histopathology. In vivo tumor-to-normal ratio (TNR), ex vivo tumor-to-background ratio (TBR), and lesion detection performance were compared between the two modalities.

RESULTS

NIR-II imaging showed higher intraoperative TNR than NIR-I imaging (10.11 ± 3.48 vs 6.49 ± 3.48, P < 0.05) and higher ex vivo TBR (16.05 ± 8.43 vs 9.88 ± 5.35, P < 0.05). In specimen-based analysis, NIR-II showed higher sensitivity (88.9% vs 77.8%) and accuracy (84.4% vs 80.0%) than NIR-I imaging. NIR-II also identified additional satellite or metastatic lesions not clearly visualized by NIR-I imaging in representative cases and improved localization of deeply located tumors.

CONCLUSION

ICG-based NIR-II fluorescence imaging is feasible in pediatric HB surgery and may provide incremental intraoperative visualization compared with NIR-I imaging, particularly for selected small, deep, or weakly fluorescent lesions. These preliminary findings support the complementary role of NIR-II imaging in intraoperative decision-making but require validation in larger studies with standardized follow-up.

LEVEL OF EVIDENCE: Level III.