Sentinel Node Biopsy by Indocyanine Green Retention Fluorescence Detection for Inguinal Lymph Node Staging of Anal Cancer: Preliminary Experience
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There is some evidence that sentinel lymph node (SLN) biopsy guided by dye injection and/or radioisotopes can improve staging of inguinal lymph nodes (LNs) in anal cancer. This study was performed to investigate the feasibility of fluorescence detection of SLN and lymphatic mapping in anal cancer.
Twelve patients with anal cancer without evidence for inguinal LN involvement were included in the study. Intraoperatively, all patients received a peritumorous injection of 25 mg indocyanine green (ICG) for fluorescence imaging of the SLN with a near-infrared camera. For comparison, conventional SLN detection by technetium-99m-sulfur radiocolloid injection in combination with blue dye was also performed in all patients. The results of both techniques and the effect on the therapeutic regimen were analyzed.
Overall, ICG fluorescence imaging identified at least one SLN in 10 of 12 patients (detection rate, 83%). With the combination of radionuclide and blue dye, SLN were detected in 9 of 12 patients (detection rate, 75%). Metastatic involvement of the SLN was found in 2 of 10 patients versus 2 of 9 patients. Patients with metastatic involvement of the SLN received extended radiation field with inguinal boost.
ICG fluorescence imaging allows intraoperative lymphatic mapping and transcutaneous SLN detection for selective biopsy of inguinal SLN in anal cancer. This technique should be further evaluated in comparative studies with larger patient numbers.
- Deans GT, McAleer JJ, Spence RA. Malignant anal tumours. Br J Surg. 1994;81:500–8. CrossRef
- Ryan DP, Compton CC, Mayer RJ. Carcinoma of the anal canal. N Engl J Med. 2000;342:792–800. CrossRef
- Schlag PM, Hunerbein M. Anal cancer: multimodal therapy. World J Surg. 1995;19:282–6. CrossRef
- Wade DS, Herrera L, Castillo NB, Petrelli NJ. Metastases to the lymph nodes in epidermoid carcinoma of the anal canal studied by a clearing technique. Surg Gynecol Obstet. 1989;169:238–42.
- Myerson RJ, Kong F, Birnbaum EH, et al. Radiation therapy for epidermoid carcinoma of the anal canal, clinical and treatment factors associated with outcome. Radiother Oncol. 2001;61:15–22. CrossRef
- Gerard JP, Chapet O, Samiei F, et al. Management of inguinal lymph node metastases in patients with carcinoma of the anal canal: experience in a series of 270 patients treated in Lyon and review of the literature. Cancer. 2001;92:77–84. CrossRef
- Bonnema J, van de Velde CJ. Sentinel lymph node biopsy in breast cancer. Ann Oncol. 2002;13:1531–7. CrossRef
- Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg. 1992;127:392–9.
- Bell SW, Mourra N, Flejou JF, Parc R, Tiret E. Ex vivo sentinel lymph node mapping in colorectal cancer. Dis Colon Rectum. 2005;48:74–9. CrossRef
- Doekhie FS, Peeters KC, Tollenaar RA, van de Velde CJ. Minimal residual disease assessment in sentinel nodes of breast and gastrointestinal cancer: a plea for standardization. Ann Surg Oncol. 2004;11(3 Suppl):236S–41S.
- Gretschel S, Bembenek A, Hunerbein M, et al. Efficacy of different technical procedures for sentinel lymph node biopsy in gastric cancer staging. Ann Surg Oncol. 2007;14:2028–35. CrossRef
- Bembenek A, Gretschel S, Schlag PM. Sentinel lymph node biopsy for gastrointestinal cancers. J Surg Oncol. 2007;96:342–52. CrossRef
- Nimura H, Narimiya N, Mitsumori N, et al. Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg. 2004;91:575–9. CrossRef
- Murawa D, Hirche C, Dresel S, Hunerbein M. Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence. Br J Surg. 2009;96:1289–94. CrossRef
- Hirche C, Murawa D, Mohr Z, Kneif S, Hunerbein M. ICG fluorescence-guided sentinel node biopsy for axillary nodal staging in breast cancer. Breast Cancer Res Treat. 2010 Feb 7 [Epub ahead of print].
- Meyer JS. Sentinel lymph node biopsy: strategies for pathologic examination of the specimen. J Surg Oncol. 1998;69:212–8. CrossRef
- Oliver GC, Labow SB. Neoplasms of the anus. Surg Clin North Am. 1994;74:1475–90.
- Damin DC, Rosito MA, Schwartsmann G. Sentinel lymph node in carcinoma of the anal canal: a review. Eur J Surg Oncol. 2006;32:247–52. CrossRef
- Perera D, Pathma-Nathan N, Rabbitt P, Hewett P, Rieger N. Sentinel node biopsy for squamous-cell carcinoma of the anus and anal margin. Dis Colon Rectum. 2003;46:1027–9. CrossRef
- Peley G, Farkas E, Sinkovics I, et al. Inguinal sentinel lymph node biopsy for staging anal cancer. Scand J Surg. 2002;91:336–8.
- Damin DC, Rosito MA, Gus P, et al. Sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal: early experience. Dis Colon Rectum. 2003;46:1032–7. CrossRef
- Gretschel S, Warnick P, Bembenek A, et al. Lymphatic mapping and sentinel lymph node biopsy in epidermoid carcinoma of the anal canal. Eur J Surg Oncol. 2008;34:890–4.
- Ulmer C, Bembenek A, Gretschel S, et al. Refined staging by sentinel lymph node biopsy to individualize therapy in anal cancer. Ann Surg Oncol. 2004;11(3 Suppl):259S–62S.
- Bobin JY, Gerard JP, Chapet O, Romestaing P, Isaac S. Lymphatic mapping and inguinal sentinel lymph node biopsy in anal canal cancers to avoid prophylactic inguinal irradiation. Cancer Radiother. 2003;7(Suppl 1):85s–90s.
- Bartelink H, Roelofsen F, Eschwege F, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15:2040–9.
- Jung H, Beck-Bornholdt HP, Svoboda V, Alberti W, Herrmann T. Quantification of late complications after radiation therapy. Radiother Oncol. 2001;61:233–46. CrossRef
- Papillon J, Montbarbon JF. Epidermoid carcinoma of the anal canal. A series of 276 cases. Dis Colon Rectum. 1987;30:324–33. CrossRef
- Sentinel Node Biopsy by Indocyanine Green Retention Fluorescence Detection for Inguinal Lymph Node Staging of Anal Cancer: Preliminary Experience
Annals of Surgical Oncology
Volume 17, Issue 9 , pp 2357-2362
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- 1. Department of General Surgery and Surgical Oncology, Robert Rössle Hospital, Helios Hospital Berlin-Buch, Berlin, Germany
- 4. Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany
- 2. Department of Nuclear Medicine, Robert Rössle Hospital, Helios Hospital Berlin-Buch, Berlin, Germany
- 3. Department of Radiotherapy, Robert Rössle Hospital, Helios Hospital Berlin-Buch, Berlin, Germany