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Indocyanine green fluorescence patterns of hepatocellular carcinoma correlate with pathological and molecular features

  • Mylène Sebagh
    Correspondence
    Correspondence: Mylène Sebagh, AP-HP Hôpital Paul-Brousse, Laboratoire d’Anatomie Pathologique, 12 avenue Paul Vaillant Couturier, 94800 Villejuif, France.
    Affiliations
    AP-HP Hôpital Paul-Brousse, Laboratoire d’Anatomopathologie, Villejuif, F-94800, France

    UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France

    Université Paris-Saclay, Villejuif, F-94800, France
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  • Christophe Desterke
    Affiliations
    UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France

    Université Paris-Saclay, Villejuif, F-94800, France
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  • Cyrille Feray
    Affiliations
    UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France

    Université Paris-Saclay, Villejuif, F-94800, France

    AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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  • Jocelyne Hamelin
    Affiliations
    AP-HP Hôpital Paul-Brousse, Plateforme de biologie moléculaire, Villejuif, F-94800, France
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  • Myriam Habib
    Affiliations
    AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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  • Didier Samuel
    Affiliations
    UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France

    Université Paris-Saclay, Villejuif, F-94800, France

    AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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  • Olivier Rosmorduc
    Affiliations
    UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France

    Université Paris-Saclay, Villejuif, F-94800, France

    AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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  • Eric Vibert
    Affiliations
    UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France

    Université Paris-Saclay, Villejuif, F-94800, France

    AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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  • Nicolas Golse
    Affiliations
    UMR-S 1193, Inserm, Physiopathogénèse et traitement des maladies du Foie, FHU Hepatinov, Villejuif, F-94800, France

    Université Paris-Saclay, Villejuif, F-94800, France

    AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Chirurgie Hépato-Biliaire et Transplantation Hépatique, Villejuif, F-94800, France
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Published:October 20, 2022DOI:https://doi.org/10.1016/j.hpb.2022.10.008

      Abstract

      Background

      Intraoperative Indocyanine Green Dye (ICG) routinely used in hepatobiliary surgery identifies different fluorescent patterns of hepatocellular carcinoma (HCC), a highly heterogeneous cancer. We aimed to correlate these patterns with gene mutations and extensive pathological features beyond the well-known tumor differentiation.

      Methods

      Between February 2017 and December 2019, 21 HCC in 16 consecutive patients who underwent intraoperative ICG fluorescence imaging were included. Pathological review was performed by one pathologist blinded to fluorescence features. Random forest machine learning algorithm correlated pathological features of the tumor, peritumoral and non-tumoral liver, and gene mutations from a 28 gene-panel with rim and intra-lesion fluorescence.

      Results

      Three HCC had negative intra-lesion and rim-like emission, 7 HCC had homogeneous pattern and 11 heterogeneous patterns in whom 3 with rim-like emission. Rim emission was associated with peritumoral vascular changes, lower differentiation and lower serum AFP level. Homogeneous intra-lesion fluorescence was associated with lower necrosis rate, thinner capsule, absence of peritumoral liver changes, and higher serum AFP level. Heterogeneous HCC without rim harbored lesser TP53 and ARID1A mutations.

      Conclusion

      Tumoral and peri-tumoral fluorescence classification of HCC yielded a possible intraoperative pathological and molecular characterization. These preliminary observations could lead to intraoperative refinement in surgical strategy.
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