Evidence map›Paper›PMID 36936453›Full record

ArticleSurgery open science2023

Real-time administration of indocyanine green in combination with computer vision and artificial intelligence for the identification and delineation of colorectal liver metastases.

Niall P Hardy, Jonathan P Epperlein, Jeffrey Dalli, William Robertson, Richard Liddy, John J Aird, Niall Mulligan, Peter M Neary, Gerard P McEntee, John B Conneely and 1 more

Open access · goldFull text read
In one paragraph

Article in Surgery open science, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
2.7field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
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  6. Article
  7. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Niall P HardyUCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland.
Jonathan P EpperleinIBM Research Europe, Dublin, Ireland.
Jeffrey DalliUCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland.
William RobertsonDepartment of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland.
Richard LiddyDepartment of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland.
John J AirdDepartment of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland.
Niall MulliganDepartment of Histopathology, Mater Misericordiae University Hospital, Dublin, Ireland.
Peter M NearyDepartment of General and Colorectal Surgery, University Hospital Waterford, University College Cork, Ireland.
Gerard P McEnteeDepartment of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
John B ConneelyDepartment of Hepatobiliary, Foregut and Bariatric Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
Ronan A CahillUCD Centre for Precision Surgery, School of Medicine, UCD, Dublin, Ireland.
Mater Misericordiae University Hospital · IEIBM Research - Ireland · IEUniversity Hospital Waterford · IE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Fluorescence guided surgery for the identification of colorectal liver metastases (CRLM) can be better with low specificity and antecedent dosing impracticalities limiting indocyanine green (ICG) usefulness currently. We investigated the application of artificial intelligence methods (AIM) to demonstrate and characterise CLRMs based on dynamic signalling immediately following intraoperative ICG administration. Methods: Twenty-five patients with liver surface lesions (24 CRLM and 1 benign cyst) undergoing open/laparoscopic/robotic procedures were studied. ICG (0.05 mg/kg) was administered with near-infrared recording of fluorescence perfusion. User-selected region-of-interest (ROI) perfusion profiles were generated, milestones relating to ICG inflow/outflow extracted and used to train a machine learning (ML) classifier. 2D heatmaps were constructed in a subset using AIM to depict whole screen imaging based on dynamic tissue-ICG interaction. Fluorescence appearances were also assessed microscopically (using H&E and fresh-frozen preparations) to provide tissue-level explainability of such methods. Results: The ML algorithm correctly classified 97.2 % of CRLM ROIs (n = 132) and all benign lesion ROIs (n = 6) within 90-s of ICG administration following initial mathematical curve analysis identifying ICG inflow/outflow differentials between healthy liver and CRLMs. Time-fluorescence plots extracted for each pixel in 10 lesions enabled creation of 2D characterising heatmaps using flow parameters and through unsupervised ML. Microscopy confirmed statistically less CLRM fluorescence vs adjacent liver (mean ± std deviation signal/area 2.46 ± 9.56 vs 507.43 ± 160.82 respectively p < 0.001) with H&E diminishing ICG signal (n = 4). Conclusion: ML accurately identifies CRLMs from surrounding liver tissue enabling representative 2D mapping of such lesions from their fluorescence perfusion patterns using AIM. This may assist in reducing positive margin rates at metastatectomy and in identifying unexpected/occult malignancies.

Indexed as

Artificial intelligenceColorectal liver metastasesFluorescence guided surgeryFluorescence quantificationIndocyanine greenLiver surgery

Identifiers

PMID36936453
PMCPMC10017420
OpenAlexW4322766690

What OpenQuestion holds

Textfull text, public
LicenceCC BY
measurements read8
identifiers read2
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.