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Sentinel Node Biopsy by Indocyanine Green Retention Fluorescence Detection for Inguinal Lymph Node Staging of Anal Cancer: Preliminary Experience

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgment

This study was supported by grants of the Helios Research Center, Berlin, Germany, and Charite-Universitätsmedizin, Berlin, Germany.

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Authors and Affiliations

  1. Department of General Surgery and Surgical Oncology, Robert Rössle Hospital, Helios Hospital Berlin-Buch, Berlin, Germany

    C. Hirche MD & M. Hünerbein MD

  2. Department of Nuclear Medicine, Robert Rössle Hospital, Helios Hospital Berlin-Buch, Berlin, Germany

    S. Dresel MD

  3. Department of Radiotherapy, Robert Rössle Hospital, Helios Hospital Berlin-Buch, Berlin, Germany

    R. Krempien MD

  4. Department of Hand, Plastic, and Reconstructive Surgery, Trauma Center Ludwigshafen, Ludwigshafen, Germany

    C. Hirche MD

Authors
  1. C. Hirche MD
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  2. S. Dresel MD
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  3. R. Krempien MD
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  4. M. Hünerbein MD
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Corresponding author

Correspondence to M. Hünerbein MD.

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Hirche, C., Dresel, S., Krempien, R. et al. Sentinel Node Biopsy by Indocyanine Green Retention Fluorescence Detection for Inguinal Lymph Node Staging of Anal Cancer: Preliminary Experience. Ann Surg Oncol 17, 2357–2362 (2010). https://doi.org/10.1245/s10434-010-1010-7

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  • DOI: https://doi.org/10.1245/s10434-010-1010-7

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