Sentinel node mapping guide by indocyanine green fluorescence imaging in gastrointestinal cancers

首先对22例经标准手术切除的胃癌患者和26例结直肠癌患者进行了吲哚菁绿（ICG）荧光成像引导下的前哨淋巴结（SN）定位。注射ICG后立即可见引流肿瘤的淋巴管和圆形SNs的明亮荧光。即使非绿色的SNs也能通过ICG荧光成像清晰可见。胃癌患者SN检出率为90.9%，结直肠癌患者SN检出率为88.5%。初步结果表明，ICG荧光成像可方便、高灵敏度、实时成像引导胃癌或结直肠癌患者的SN定位。（Dig Surg 2008; 25: 103-8）其次，对56例胃癌患者进行ICG荧光成像引导下的SN定位。与ct2或ct3期癌症相比，ct1期癌症的准确率明显更高（97.2% vs. 72.2%， P=0.0127）。ct1期的假阴性率为14.3%，ct2或ct3期的假阴性率为50.0%。这些数据表明，ICG荧光成像引导下的SN定位可能有助于预测胃癌，特别是c1期胃癌的淋巴结转移情况。（Ann Surg 2009; 249: 58-62）最后，对77例行腹腔镜辅助胃切除术（LAG组，38例）或常规开放式胃切除术（OG组，39例）的ct1期或ct2期胃癌患者进行ICG荧光成像引导下的SN定位。LAG组的检出率和平均荧光节点数（FNs）分别为94.7%和7.9，OG组的检出率和平均荧光节点数分别为94.9%和7.2。LAG组的准确率为97.2%，假阴性率为25%；OG组的准确率为91.9%，假阴性率为23.1%。在33例LAG组和27例OG组无SN转移的患者中，仅在与检测到的SN位于同一淋巴池的非SN中发现淋巴结转移。这些数据表明，腹腔镜手术切除含有淋巴结的淋巴池可能是一种很有希望的新型微创手术方法，适用于无淋巴结转移的cT1或ct2期胃癌患者。(Ann Surg Oncol 2010年2月17日；Epub提前印刷

At first, sentinel node (SN) mapping guided by indocyanine green (ICG) fluorescence imaging was conducted in 22 patients with gastric cancer and 26 patients with colorectal cancer who had undergone standard surgical resection. Immediately after the ICG injection, lymphatic vessels draining the tumor and round-shaped SNs were visualized by their bright fluorescence. Even SNs that were not green in color could be easily and clearly visualized by ICG fluorescence imaging. The SN detection rate was 90.9% in patients with gastric cancer, and 88.5% in patients with colorectal cancer. The preliminary results show that ICG fluorescence imaging allows easy, highly sensitive and real-time imaging-guided SN mapping in patients with gastric or colorectal cancer. (Dig Surg 2008 ; 25 : 103-8)Secondly, SN mapping guided by ICG fluorescence imaging was conducted in 56 patients with gastric cancer. cT1-stage cancers were associated with a significantly higher accuracy rate (97.2% vs. 72.2%, P=0.0127) t … More han cT2-or cT3-stage cancers. A false-negative rate was 14.3% in cT1-stage cancers and 50.0% in cT2-or cT3-stage cancers, respectively. These data suggest that SN mapping guided by ICG fluorescence imaging might be useful for predicting the metastatic status in lymph nodes in cases of gastric cancer, especially those with cT1-stage cancer. (Ann Surg 2009 ; 249 : 58-62)Finally, SN mapping guided by ICG fluorescence imaging was conducted in 77 patients with cT1-or cT2-stage gastric cancer who had undergone laparoscopy-assisted gastrectomy (LAG group ; 38 patients) or conventional open gastrectomy (OG group ; 39 patients). The detection rate and mean number of fluorescent nodes (FNs) were 94.7% and 7.9, respectively, in the LAG group, and 94.9% and 7.2, respectively, in the OG group. The accuracy and false-negative rates were 97.2% and 25%, respectively, in the LAG group, and 91.9% and 23.1%, respectively, in the OG group. Among 33 LAG group patients and 27 OG group patients without SN metastasis, lymph node metastasis was found only in non-SNs located in the same lymphatic basin as the detected SNs. These data suggest that dissection of the lymphatic basin containing SNs with laparoscopic surgery may be a promising approach as a new type of minimally invasive surgery for patients with cT1- or cT2-stage gastric cancer having no metastasis in SNs. (Ann Surg Oncol 2010 Feb 17 ; Epub ahead of print) Less