Sentinel Lymph Node Biopsy Using Intraoperative Indocyanine Green Fluorescence Imaging Navigated with Preoperative CT Lymphography for Superficial Esophageal Cancer
| Autor: | Takeshi Nishino, Yota Yamamoto, Hiromichi Yamai, Hirokazu Takechi, Seiya Inoue, Takuya Minato, Yoshihito Furukita, Junichi Seike, Satoshi Fujiwara, Akira Tangoku, Yasuhiro Yuasa, Masakazu Goto, Takahiro Yoshida |
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| Rok vydání: | 2011 |
| Předmět: |
Indocyanine Green
medicine.medical_specialty Esophageal Neoplasms Sentinel lymph node Fluorescence Computed tomographic chemistry.chemical_compound Surgical oncology Biopsy medicine Humans Coloring Agents Aged Neoplasm Staging medicine.diagnostic_test Sentinel Lymph Node Biopsy business.industry Lymphography Middle Aged Esophageal cancer Prognosis medicine.disease eye diseases Esophagectomy Survival Rate Oncology chemistry Lymphatic Metastasis Feasibility Studies Lymph Node Excision Surgery Lymph Nodes Radiology Tomography X-Ray Computed business Indocyanine green Follow-Up Studies Indocyanine green fluorescence |
| Zdroj: | Annals of Surgical Oncology. 19:486-493 |
| ISSN: | 1534-4681 1068-9265 |
| DOI: | 10.1245/s10434-011-1922-x |
| Popis: | The sentinel lymph node (SLN) concept has been gaining attention for gastrointestinal neoplasms but remains controversial for esophageal cancer. This study evaluated the feasibility of SLN identification using intraoperative indocyanine green (ICG) fluorescence imaging (IGFI) navigated by preoperative computed tomographic lymphography (CTLG) to treat superficial esophageal cancer.Subjects comprised 20 patients clinically diagnosed with superficial esophageal cancer. Five minutes after endoscopic submucosal injection of iopamidol around the primary lesion using a four-quadrant injection pattern with a 23-gauge endoscopic injection sclerotherapy needle, three-dimensional multidetector computed tomography was performed to identify SLNs and lymphatic routes. ICG solution was injected intraoperatively around the tumor. Fluorescence imaging was obtained by infrared ray electronic endoscopy. Thoracoscope-assisted standard radical esophagectomy with lymphadenectomy was performed to confirm fluorescent lymph nodes detected by CTLG.Lymphatic vessels and SLNs were identified preoperatively using CTLG in all cases. Intraoperative detection rates were 100% using CTLG and 95% using IGFI. Lymph node metastases were found in four cases, including one false-negative case with SLNs occupied by bulky metastatic tumor that were not enhanced with both methods. The other 19 cases, including three cases of metastatic lymph nodes, were accurately identified by both procedures.Preoperative CTLG visualized the correct number and site of SLNs in surrounding anatomy during routine computed tomography to evaluate distant metastases. Referring to CTLG, SLNs were identified using IGFI, resulting in successful SLN navigation and saving time and cost. This method appears clinically applicable as a less-invasive method for treating superficial esophageal cancer. |
| Databáze: | OpenAIRE |
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