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

首先在吲哚青绿(ICG)荧光成像引导下，对22例胃癌和26例结直肠癌患者行标准手术切除前哨淋巴结(SN)标测。注射ICG后，立即可见引流肿瘤的淋巴管和圆形的SNs，可见其明亮的荧光。即使是颜色不是绿色的SNS，也可以通过ICG荧光成像轻松而清晰地显示出来。胃癌组SN的检出率为90.9%，结直肠癌组为88.5%。初步结果表明，ICG荧光成像可以方便、高灵敏度和实时成像引导的SN标测在胃或结直肠癌患者中。(Dig Surg 2008；25：103-8)其次，在ICG荧光成像引导下对56例胃癌患者进行SN标测。CT1期癌的准确率显著高于…(97.2%vs.72.2%，P=0.0127)更多的汉族人ct2或ct3期癌症。CT1期癌的假阴性率为14.3%，CT2或CT3期癌的假阴性率为50.0%。提示ICG荧光成像引导下的SN标测可能有助于预测胃癌，尤其是CT1期胃癌的淋巴结转移情况。(Ann Surg 2009；249：58-62)最后，在ICG荧光成像引导下，对77例ct1或ct2期胃癌患者行腹腔镜辅助胃切除术(LAG组，38例)或传统开腹胃切除术(OG组，39例)。LAG组和OG组的荧光结节发现率分别为94.7%和94.9%，平均荧光结节数分别为7.9和7.2。滞后组的准确率和假阴性率分别为97.2%和25%，OG组的准确率和假阴性率分别为91.9%和23.1%。在33例LAG组和27例OG组中，无SN转移的患者仅在与被检出的SN位于同一淋巴盆内的非SN中发现有淋巴结转移。这些数据表明，对于无淋巴结转移的ct1或ct2期胃癌患者，腹腔镜手术切除含淋巴结的淋巴池可能是一种有前途的新型微创手术。(Ann Surg Oncol2010年2月17日；Epub预印本)

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