Clinical applications of indocyanine green fluorescence for the treatment of hepatocellular carcinoma

Over the past ten years, numerous papers have been published on the use of indocyanine green (ICG) fluorescence in liver surgery for hepatocellular carcinoma (HCC). There are many different applications. The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface. In a minimally invasive setting, the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging. ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster. ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation. ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.