Intraoperative imaging of renal cortical tumors and cysts

Abstract

The invention provides methods for visualizing renal tumors and for staging cysts during an operation by use of a fluorescent dye.

What is claimed is: 
     
       1. A method of detecting the presence or absence of a tumor in an area of a kidney in a subject during a surgical operation, comprising:
 a) intravenously administering to said subject indocyanine green (ICG) which fluoresces at a near infrared emission wavelength when said dye is contacted with a near infrared excitation wavelength; 
 b) illuminating said kidney during said operation with said near infrared excitation wavelength such that the ICG in said kidney fluoresces; and, 
 c) detecting the presence or absence of fluorescence of the ICG in said kidney during said operation, using a video camera with optical filtering to block ambient and laser light, wherein detecting absence of fluorescence in said area indicates the presence of a tumor in said area, and detecting the presence of fluorescence in said area indicates the absence of a tumor in said area. 
 
     
     
       2. A method of  claim 1 , wherein there are a plurality of tumors in said kidney. 
     
     
       3. A method of  claim 1 , wherein said dye is administered locally into the renal artery, the superior segmental artery, anterior superior segmental artery, anterior inferior segmental artery, inferior segmental artery, an arcuate artery, or an interlobular artery. 
     
     
       4. A method of  claim 1 , wherein said tumor is visualized on an image display. 
     
     
       5. A method of  claim 1 , wherein said exposing of said kidney to said illumination comprising said excitation wavelength is by a laproscopic instrument. 
     
     
       6. A method of  claim 1 , wherein the subject is a human. 
     
     
       7. A method of  claim 1 , wherein said dye is administered during said surgical operation. 
     
     
       8. A method of  claim 1 , wherein said dye is administered within 1 hour before said surgical operation. 
     
     
       9. A method of  claim 8 , wherein said dye is administered within about ½ hour before said surgical operation. 
     
     
       10. A method of  claim 8 , wherein said dye is administered within about ½ hour before said surgical operation. 
     
     
       11. A method of visualizing a tumor in a kidney in a subject during a surgical operation, comprising:
 a) intravenously administering to said subject indocyanine green (ICG) which fluoresces at a near infrared emission wavelength when said dye is contacted with a near infrared excitation wavelength; 
 b) illuminating said kidney during said operation with said near infrared excitation wavelength such that the ICG in said kidney fluoresces; and, 
 c) visualizing the presence or absence of fluorescence of the ICG in said kidney during said operation, using a video camera with optical filtering to block ambient and laser light, wherein visualizing an area of said kidney in which fluorescence is absent is a visualization of said tumor. 
 
     
     
       12. A method of  claim 11 , wherein there are a plurality of tumors in said kidney. 
     
     
       13. A method of  claim 11 , wherein said dye is administered locally into the renal artery, the superior segmental artery, anterior superior segmental artery, anterior inferior segmental artery, inferior segmental artery, an arcuate artery, or an interlobular artery. 
     
     
       14. A method of  claim 11 , wherein said tumor is visualized on an image display. 
     
     
       15. A method of  claim 11 , wherein said exposing of said kidney to said illumination comprising said excitation wavelength is by a laproscopic instrument. 
     
     
       16. A method of  claim 11 , wherein the subject is a human. 
     
     
       17. A method of  claim 11 , wherein said dye is administered during said surgical operation. 
     
     
       18. A method of  claim 11 , wherein said dye is administered within 1 hour before said surgical operation. 
     
     
       19. A method of visualizing a tumor margin in tissue excised from a kidney during a surgical operation, comprising:
 a) intravenously administering to said subject indocyanine green (ICG) which fluoresces at a near infrared emission wavelength when said dye is contacted with a near infrared excitation wavelength, 
 b) excising some or all of a tumor and surrounding tissue from said kidney during said operation, 
 c) illuminating said kidney during said operation with said near infrared excitation wavelength such that the ICG in said kidney fluoresces; and 
 d) visualizing the presence or absence of fluorescence of the ICG, using a video camera with optical filtering to block ambient and laser light, wherein visualizing fluorescence around said some or all of said tumor indicates the presence of a tumor margin, and an absence of said fluorescence around some or all of said tumor indicates the absence of a tumor margin. 
 
     
     
       20. A method of  claim 19 , wherein there are a plurality of tumors in said kidney. 
     
     
       21. A method of  claim 19 , wherein said dye is administered locally into the renal artery, the superior segmental artery, anterior superior segmental artery, anterior inferior segmental artery, inferior segmental artery, an arcuate artery, or an interlobular artery. 
     
     
       22. A method of  claim 19 , wherein said tumor and any surrounding tissue is visualized on an image display. 
     
     
       23. A method of  claim 19 , wherein the subject is a human. 
     
     
       24. A method of determining during a surgical operation whether a cyst in a kidney in a subject is benign or contains malignant cells, comprising:
 a) intravenously administering to said subject a dye indocyanine green (ICG) which fluoresces at an a near infrared emission wavelength when said dye ICG is contacted with an a near infrared excitation wavelength; 
 b) illuminating said cyst during said operation with said near infrared excitation wavelength under conditions such that the ICG in said cyst fluoresces; and, 
 c) comparing the fluorescence of said dye the ICG in said cyst during said operation to the fluorescence of surrounding kidney tissue, using a video camera with optical filtering to block ambient and laser light, wherein bright fluorescence in said cyst compared to said surrounding kidney tissue indicates that the cyst is benign and low or no fluorescence in said cyst compared to said surrounding kidney tissue indicates that the cyst contains malignant cells. 
 
     
     
       25. A method of  claim 24 , wherein said dye is administered locally into the renal artery, the superior segmental artery, anterior superior segmental artery, anterior inferior segmental artery, inferior segmental artery, an arcuate artery, or an interlobular artery. 
     
     
       26. A method of  claim 24 , wherein said cyst is visualized on an image display. 
     
     
       27. A method of  claim 24 , wherein said exposing of said cyst to said illumination comprising said excitation wavelength is by a laproscopic instrument.