Piccolo G, Barabino M, Benuzzi L, Formisano G, Bianchi PP. Clinical applications of indocyanine green fluorescence for the treatment of hepatocellular carcinoma. World J Gastrointest Oncol 2026; 18(1): 114339 [DOI: 10.4251/wjgo.v18.i1.114339]
Corresponding Author of This Article
Gaetano Piccolo, MD, PhD, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudinì 8, Milan 20142, Lombardy, Italy. gpiccolo1983@gmail.com
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Surgery
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 15, 2026 (publication date) through Jan 12, 2026
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World Journal of Gastrointestinal Oncology
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1948-5204
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Piccolo G, Barabino M, Benuzzi L, Formisano G, Bianchi PP. Clinical applications of indocyanine green fluorescence for the treatment of hepatocellular carcinoma. World J Gastrointest Oncol 2026; 18(1): 114339 [DOI: 10.4251/wjgo.v18.i1.114339]
World J Gastrointest Oncol. Jan 15, 2026; 18(1): 114339 Published online Jan 15, 2026. doi: 10.4251/wjgo.v18.i1.114339
Clinical applications of indocyanine green fluorescence for the treatment of hepatocellular carcinoma
Gaetano Piccolo, Matteo Barabino, Laura Benuzzi, Giampaolo Formisano, Paolo Pietro Bianchi
Gaetano Piccolo, Matteo Barabino, Laura Benuzzi, Giampaolo Formisano, Paolo Pietro Bianchi, Department of Health Sciences, University of Milan, San Paolo Hospital, Milan 20142, Lombardy, Italy
Author contributions: Piccolo G designed research; Piccolo G performed research; Benuzzi L contributed new analytic tools; Piccolo G, Barabino M, Formisano G and Bianchi PP analyzed data; Piccolo G, Benuzzi L and Bianchi PP wrote the paper.
Conflict-of-interest statement: All authors have no conflict of interest to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gaetano Piccolo, MD, PhD, Department of Health Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudinì 8, Milan 20142, Lombardy, Italy. gpiccolo1983@gmail.com
Received: September 17, 2025 Revised: October 31, 2025 Accepted: December 16, 2025 Published online: January 15, 2026 Processing time: 117 Days and 19.4 Hours
Abstract
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.
Core Tip: We report the clinical application of indocyanine green (ICG) fluorescence in the treatment of hepatocellular carcinoma (HCC). In minimally invasive surgery, ICG is used for precise delineation of hepatic segments during anatomical liver resection. This innovative technique can also serve as a powerful tool for detecting superficial HCC in patients with macronodular cirrhosis through intravenous ICG injection prior to surgery. The relationship between ICG fluorescence patterns and microinvasive components is of particular interest, such as vascular microinfiltration of the portal or hepatic veins, bile duct infiltration, and the presence of satellite nodules. Finally, a new frontier in ICG fluorescence lies in its ability to identify lymphatic drainage pathways and sentinel lymph nodes during surgery, although further research is needed to optimize its application.
