Help guide our efforts to modernize
Send us your comments by March 14, 2020. Menu

Electromagnetic Tracking and Optical Imaging With ICG for Hepatic Biopsies

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT04258566
Recruitment Status : Enrolling by invitation
First Posted : February 6, 2020
Last Update Posted : February 21, 2020
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC)

Brief Summary:


Liver cancer is the sixth most common cancer worldwide. Diagnosing liver cancer usually requires a liver sample. Getting the best sample helps determine whether cancer is present and what kind of cancer it is. But sampling can be difficult. This study will look at combining two devices to provide better liver samples.


To see if combining fusion imaging and optical imaging can better sample areas of concern in the liver and determine the presence of disease.


People ages 18 and older who need a liver biopsy as part of diagnosis or treatment.


Participants will be screened with:

Review of imaging

Medical history

Physical exam

Blood test results

Participants will have a dye injected into a vein 24 hours before their biopsy. They will be monitored for 30 minutes for any side effects.

For the biopsy, participants skin will be numbed. They may have stickers placed on their belly to help guide the needle. They will have a CT scan to plan the needle s pathway. For the scan, they will lie in a machine that takes pictures of the body. A small camera will be placed near the needle to take pictures of the liver. A medical GPS tracking system will be used. This will guide the needle into the area of the participant s liver where the biopsy will be taken.

After the biopsy, participants will recover in the hospital for 4 6 hours.

After the procedure, researchers will take the participants biopsy tissue and look at it to try to compare new ways to picture the sample.

Condition or disease Intervention/treatment Phase
Hepatocellular Carcinoma Device: Optical Molecular Imaging Radiation: Indocyanine Green Phase 1

Detailed Description:
  • Pilot study to evaluate the combination of optical molecular imaging (OMI) and EM tracking in localizing intrahepatic lesions and assess the concordance between fluorescence ICG and histopathology for the diagnosis of liver cancer.
  • Hepatocellular Carcinoma (HCC) is the 3rd most common cause of cancer globally with an increasing incidence worldwide. Percutaneous sampling of focal hepatic lesions is a cornerstone in management of patients with hepatic pathology. In a retrospective study of patients with small hepatic lesions, up to 45% of the lesions biopsied were insufficiently visualized and resulted to a false negative rate (defined as patients with benign biopsies who were subsequently found to have malignant lesions at the attempted site of biopsy). Thirty seven percent of those were for HCC.
  • EM navigation and fusion of real-time images with pre-acquired scans has been used in hepatic biopsies at the NIH for more than 15 years. NIH / NCI clinical trials have performed fusion biopsies with EM tracking in > 2000 patients, > 40,000 biopsies over the past 12 years.
  • Indocyanine green (ICG) is an FDA approved optical molecular imaging fluorescent dye used for visualization of cells and tissues. ICG has been used for decades in ophthalmology for imaging retinal blood vessels. ICG was FDA cleared in 1959 and has been widely used to assess liver function perioperatively. ICG is administered as an injection. Adverse effects are rare and most often minor.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 77 participants
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Diagnostic
Official Title: A Feasibility Study to Evaluate the Combination of Electromagnetic Tracking and Optical Imaging With Indocyanine Green (ICG) for Hepatic Biopsies
Estimated Study Start Date : February 26, 2020
Estimated Primary Completion Date : December 31, 2024
Estimated Study Completion Date : December 31, 2030

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Suspected hepatic malignancy
Malignancy determination of new onset hepatic lesion
Device: Optical Molecular Imaging
Tracks and localizes intrahepatic lesions

Radiation: Indocyanine Green
Fluorescent dye used for visualization of cells and tissue

Primary Outcome Measures :
  1. ICG Fluorescene [ Time Frame: Liver Parenchyma, Target Lesion, Ex Vivo ]
    Measurements will be obtained during hepatic biopsy procedure

Secondary Outcome Measures :
  1. In vivo fluorescence [ Time Frame: At time of biopsy ]
    Assess concordance of ICG fluorescence at invivo site of biopsy with presence or absence of malignancy as defined by pathology

  2. Exvivo fluorescence [ Time Frame: Post biopsy ]
    Assess concordance of ICG fluorescence at exvivo site of biopsy with presence or absence of malignancy as defined by pathology

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

In order be eligible to participate in this study, an individual must meet all of the following criteria:

  • Patients must have imaging findings consistent with hepatocellular carcinoma or other liver neoplasms or metastasis, for whom image-guided percutaneous biopsy is planned as clinically indicated or IRB-approved under a separate research protocol.
  • Patients must have at least one lesion that can readily be biopsied per Principal Investigator.
  • Age >18 years.
  • Patients must have the ability to understand and the willingness to sign a written informed consent document.
  • Evidence of post-menopausal status or negative urinary or serum pregnancy test for female pre-menopausal patients. Women will be considered post-menopausal if they verbally report amenorrhea for 12 months without an alternative medical cause, or have had surgery or received chemicals to induce menopause.


  • History of hypersensitivity reactions to Indocyanine Green (ICG), iodinated contrast, or sulfur-containing compounds.
  • Pregnant women and nursing mothers are excluded from this study because of exposure to radiation from CT scanning associated with the biopsy
  • Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, or psychiatric illness/social situations that, in the opinion of the Principal Investigator, would limit compliance with study requirements

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT04258566

Layout table for location information
United States, Maryland
National Institutes of Health Clinical Center
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Institutes of Health Clinical Center (CC)
Layout table for investigator information
Principal Investigator: Bradford J Wood, M.D. National Institutes of Health Clinical Center (CC)

Additional Information:
Layout table for additonal information
Responsible Party: National Institutes of Health Clinical Center (CC) Identifier: NCT04258566    
Other Study ID Numbers: 200039
First Posted: February 6, 2020    Key Record Dates
Last Update Posted: February 21, 2020
Last Verified: February 4, 2020

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC):
Hepatic Carcinoma
Optical Imaging
Additional relevant MeSH terms:
Layout table for MeSH terms
Carcinoma, Hepatocellular
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Liver Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Digestive System Diseases
Liver Diseases