A clinical trial of intraoperative near-infrared imaging to assess tumor extent and identify residual disease during anterior mediastinal tumor resection

Jarrod D. Predina, Jane Keating, Andrew Newton, Christopher Corbett, Leilei Xia, Michael Shin, Lydia Frenzel Sulyok, Charuhas Deshpande, Leslie Litzky, Shuming Nie, John C. Kucharczuk, Sunil Singhal

Research output: Contribution to journalArticle


Background: The management of most solid tumors of the anterior mediastinum involves complete resection. Because of their location near mediastinal structures, wide resection is not possible; therefore, surgeons must use subjective visual and tactile cues to determine disease extent. This clinical trial explored intraoperative near-infrared (NIR) imaging as an approach to improving tumor delineation during mediastinal tumor resection. Methods: Twenty-five subjects with anterior mediastinal lesions suspicious for malignancy were enrolled in an open-label feasibility trial. Subjects were administered indocyanine green (ICG) at a dose of 5 mg/kg, 24 hours before resection (via a technique called TumorGlow). The NIR imaging systems included Artemis (Quest, Middenmeer, the Netherlands) and Iridium (VisionSense Corp, Philadelphia, Pennsylvania). Intratumoral ICG uptake was evaluated. The clinical value was determined via an assessment of the ability of NIR imaging to detect phrenic nerve involvement or incomplete resection. Clinical and histopathologic variables were analyzed to determine predictors of tumor fluorescence. Results: No drug-related toxicity was observed. Optical imaging added a mean of 10 minutes to case duration. Among the subjects with solid tumors, 19 of 20 accumulated ICG. Fluorescent tumors included thymomas (n = 13), thymic carcinomas (n = 4), and liposarcomas (n = 2). NIR feedback improved phrenic nerve dissection (n = 4) and identified residual disease (n = 2). There were no false-positives or false-negatives. ICG preferentially accumulated in solid tumors; this was independent of clinical and pathologic variables. Conclusions: NIR imaging for anterior mediastinal neoplasms is safe and feasible. This technology may provide a real-time tool capable of determining tumor extent and specifically identify phrenic nerve involvement and residual disease.

Original languageEnglish (US)
Pages (from-to)807-817
Number of pages11
Issue number5
StatePublished - Mar 1 2019



  • anterior mediastinum
  • indocyanine green (ICG)
  • intraoperative imaging
  • optical imaging
  • surgery
  • thymoma

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Predina, J. D., Keating, J., Newton, A., Corbett, C., Xia, L., Shin, M., Frenzel Sulyok, L., Deshpande, C., Litzky, L., Nie, S., Kucharczuk, J. C., & Singhal, S. (2019). A clinical trial of intraoperative near-infrared imaging to assess tumor extent and identify residual disease during anterior mediastinal tumor resection. Cancer, 125(5), 807-817. https://doi.org/10.1002/cncr.31851