{"doi":"10.1002/cac2.12236","title":"Detection of pancreatic cancer by indocyanine green‐assisted fluorescence imaging in the first and second near‐infrared windows","abstract":"Dear Editor, In the United States, pancreatic cancer is considered the fourth most common reason for cancer-related deaths; over 53% of patients are diagnosed at end-stage with a 5-year survival rate of less than 3% [1]. Incomplete removal of all cancerous cells generally leads to local recurrence of pancreatic cancer [2]. Thus, the detection of tumor margin status plays an essential role in the complete resection of pancreatic cancer. Most of the existing imaging modalities, like computed tomography and magnetic resonance imaging, are primarily used for preoperative planning; these modalities also have issues of bulky equipment, radiation concerns, and slow imaging speed [2]. Thus, these modalities can neither provide an intraoperative diagnosis of cancer with high sensitivity and specificity nor be used to define tumor margins [3]. Indocyanine green (ICG), a clinically approved fluorescent dye, has become a popular choice in various clinical applications, e.g., dental imaging [4, 5]. Many studies suggested that ICG could become an ideal fluorescent agent to enhance the imaging contrast between normal tissues and certain tumors, such as breast cancer, gastric cancer, head and neck cancer, and pancreatic tumor [6]. However, most of the existing studies using ICG performed the imaging in the first near-infrared window (NIR-I, 700-1000 nm) [6]. Compared to traditional NIR-I, imaging in the second NIR window (NIR-II, 1000-1700 nm) could achieve a deeper tissue penetration depth and acquire good imaging quality because of its low autofluorescence and photon scattering[7], especially with ICG [8]. Existing studies reported ICG-assisted NIR fluorescence imaging in NIR-II (ICG-NIRF-II) for the detection of thoracic malignancy[9] and human dental diseases [4]. To our best knowledge, no previous study has reported the use of ICG-NIRF-II to image pancreatic cancer in humans. In this letter, we designed an ICG-NIRF imaging system (Figure 1A) and used the U.S. Food and Drug Administration (FDA)-approved ICG as the fluorescent agent to image murine and human pancreatic cancers in both NIR-I and NIR-II (Supplementary file). Nine patients diagnosed with pancreatic neuroendocrine tumor (PNET) and 1 with pancreatic ductal adenocarcinoma (PDAC) (stage I-III) at the Ochsner Medical Center-Kenner of Louisiana State University Health Sciences Center (New Orleans, LA, USA) were enrolled. Human tumor specimens were collected during standard-of-care surgical procedures. Under light microscope, the excised PNET was more solid with a deeper staining in purple blue color, due to the hyperplasia of tumor cells, than the adjacent normal pancreatic tissue (Supplementary Figure S1). Informed written consent was obtained from each patient. For patients with PNET, 7 were dosed with ICG at 0.22 mg/kg and 2 at 0.50 mg/kg through intravenous injection. The patient with PDAC was dosed with ICG at 0.22 mg/kg. Intraoperative ex vivo imaging of tumor and tumor margins was then performed. Ten female immunocompetent athymic nude Nu/J mice of about 6-8 weeks old, transplanted with CFPAC-1 cells, were used as the animal model for ICG-NIRF imaging with 0.22 mg/kg. In the mouse model, tumor tissues demonstrated higher fluorescence intensity than normal tissues under both ICG-NIRF-I and ICG-NIRF-II imaging. In the short imaging window (4 h), ICG-NIRF-II had a higher tumor-background ratio (TBR) of the fluorescence peak intensities than ICG-NIRF-I (4.30 ± 0.38 vs. 2.16 ± 0.06); ICG-NIRF-I had a higher TBR in the long imaging window (24 h) than in the short imaging window (11.42 ± 1.28 vs. 2.16 ± 0.06) (Figure 1B-D). Thus, all those TBRs (>2.0) of the short and long imaging windows indicate that tumors were positive under both ICG-NIRF-I and ICG-NIRF-II imaging, which was consistent with the definition in previously published studies on other cancer types[10]. In human patients, we found that both ICG-NIRF-I and ICG-NIRF-II imaging could identify PNET: the tumor tissues show","journal":"Cancer Communications","year":2021,"id":169645,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":29,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.959,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":700749,"name":"Zheng Li","orcid":"0000-0001-9511-0701","position":1,"is_corresponding":false},{"id":701412,"name":"Alexandra Ramos","orcid":null,"position":2,"is_corresponding":false},{"id":701413,"name":"J. Philip Boudreaux","orcid":null,"position":3,"is_corresponding":false},{"id":700750,"name":"Ramcharan Thiagarajan","orcid":"0000-0001-6390-6182","position":4,"is_corresponding":false},{"id":701414,"name":"Yvette Bren Mattison","orcid":null,"position":5,"is_corresponding":false},{"id":700751,"name":"Michael E. Dunham","orcid":"0000-0002-4972-8137","position":6,"is_corresponding":false},{"id":701415,"name":"Andrew J. McWhorter","orcid":null,"position":7,"is_corresponding":false},{"id":700752,"name":"Qing Chen","orcid":"0000-0002-7919-5159","position":8,"is_corresponding":false},{"id":700753,"name":"Jian Zhang","orcid":"0000-0002-6595-8602","position":9,"is_corresponding":false},{"id":700754,"name":"Ji‐Ming Feng","orcid":"0000-0001-7956-2126","position":10,"is_corresponding":false},{"id":700755,"name":"Yanping Li","orcid":"0000-0002-8140-5565","position":11,"is_corresponding":false},{"id":395658,"name":"Shaomian Yao","orcid":"0000-0002-3697-6043","position":12,"is_corresponding":false},{"id":700748,"name":"Zhongqiang Li","orcid":"0000-0001-6962-5146","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-18T23:46:15.560174Z","pmid":"34787963","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}