Surgical Endoscopy

, Volume 33, Issue 4, pp 1235–1243 | Cite as

Sentinel node navigation surgery using near-infrared indocyanine green fluorescence in early gastric cancer

  • Dong-Wook Kim
  • Bosu Jeong
  • Il-hyung Shin
  • Uk Kang
  • Yoontaek Lee
  • Young Suk Park
  • Sang-Hoon AhnEmail author
  • Do Joong Park
  • Hyung-Ho Kim



The aim of this study was to evaluate the feasibility of indocyanine green (ICG) fluorescent method for sentinel lymph node detection in early gastric cancer.


Between December 2012 and December 2014, 28 cases of pilot examination were performed at Seoul National University Bundang Hospital. Advanced version of multispectral fluorescence organoscope was used to identify sentinel node by quantitative estimation of ICG fluorescent signal intensity. Sensitivity, specificity, false positive value were analyzed and compared with dual tracer method.


A total of 443 lymph nodes in 28 cases were examined and 184 sentinel nodes (41.5%) were identified by dual tracer method. The sensitivity using near-infrared ICG method was 98.9%. The specificity was 76.0% and false positive rate was 25.4% compared with dual tracer method. The adequate threshold for sentinel node detection was considered as 10% of maximum signal intensity.


New near-infrared ICG fluorescent method could be a promising protocol for sentinel node navigation surgery in early gastric cancer.


Sentinel node navigation surgery Early gastric cancer ICG fluorescent signal intensity 



This work was funded by the Seoul Metropolitan Government, Korea, under Contract of R & BD Program WR100001.

Compliance with ethical standards


Dong-Wook Kim, Bosu Jeong, Il-hyung Shin, Uk Kang, Yoontaek Lee, Young Suk Park, Sang-Hoon Ahn, Do Joong Park, and Hyung-Ho Kim have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by Institutional Review Board of Seoul National University Bundang Hospital (registration number: E-1208/167007). The patients were fully informed of the study and filled out a written informed consent. This study was conducted according to the principles of the Declaration of Helsinki.

Supplementary material

Supplementary material 1 (MP4 189198 KB)


  1. 1.
    Information Committee of Korean Gastric Cancer Association (2016) Korean gastric cancer association nationwide survey on gastric cancer in 2014. J Gastric Cancer 16(3):131–140CrossRefGoogle Scholar
  2. 2.
    Katai H, Ishikawa T, Akazawa K, Isobe Y, Miyashiro I, Oda I, Tsujitani S, Ono H, Tababe S, Fukagawa T, Nunobe S, Kakeji Y, Nashimoto A, Registration Committee of the Japanese Gastric Cancer Association (2017) Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer. CrossRefPubMedGoogle Scholar
  3. 3.
    Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3(4):219–225CrossRefPubMedGoogle Scholar
  4. 4.
    Sasako M, McCulloch P, Kinoshita T, Maruyama K (1995) New method to evaluate the therapeutic value of lymph node dissection for gastric cancer. Br J Surg 82(3):346–351CrossRefPubMedGoogle Scholar
  5. 5.
    Park DJ, Kim HH, Park YS, Lee HS, Lee WW, Lee HJ, Yang HK (2011) Simultaneous indocyanine green and (99m)Tc-antimony sulfur colloid-guided laparoscopic sentinel basin dissection for gastric cancer. Ann Surg Oncol 18(1):160–165. CrossRefPubMedGoogle Scholar
  6. 6.
    Park JY, Kook MC, Eom BW, Yoon HM, Kim SJ, Rho JY, Kim SK, Kim YI, Cho SJ, Lee JY, Kim CG, Choi IJ, Kim YW, Ryu KW (2016) Practical intraoperative pathologic evaluation of sentinel lymph nodes during sentinel node navigation surgery in gastric cancer patients—proposal of the pathologic protocol for the upcoming SENORITA trial. Surg Oncol 25(3):139–146. CrossRefGoogle Scholar
  7. 7.
    Lee HS, Lee HE, Park DJ, Park YS, Kim HH (2012) Precise pathologic examination decreases the false-negative rate of sentinel lymph node biopsy in gastric cancer. Ann Surg Oncol 19(3):772–778. CrossRefPubMedGoogle Scholar
  8. 8.
    Kitagawa Y, Takeuchi H, Takagi Y, Natsugoe S, Terashima M, Murakami N, Fujimura T, Tsujimoto H, Hayashi H, Yoshimizu N, Takagane A, Mohri Y, Nabeshima K, Uenosono Y, Kinami S, Sakamoto J, Morita S, Aikou T, Miwa K, Kitajima M (2013) Sentinel node mapping for gastric cancer: a prospective multicenter trial in Japan. J Clin Oncol 31(29):3704–3710. CrossRefPubMedGoogle Scholar
  9. 9.
    Takeuchi H, Kitagawa Y (2013) New sentinel node mapping technologies for early gastric cancer. Ann Surg Oncol 20(2):522–532. CrossRefPubMedGoogle Scholar
  10. 10.
    Mitsumori N, Nimura H, Takahashi N, Kawamura M, Aoki H, Shida A, Omura N, Yanaga K (2014) Sentinel lymph node navigation surgery for early stage gastric cancer. World J Gastroenterol 20(19):5685–5693. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kitagawa Y, Fujii H, Mukai M, Kubota T, Ando N, Watanabe M, Ohgami M, Otani Y, Ozawa S, Hasegawa H, Furukawa T, Kumai K, Ikeda T, Nakahara T, Kubo A, Kitajima M (2000) The role of the sentinel lymph node in gastrointestinal cancer. Surg Clin North Am 80(6):1799–1809CrossRefPubMedGoogle Scholar
  12. 12.
    Yoshida M, Kubota K, Kuroda J, Ohta K, Nakamura T, Saito J, Kobayashi M, Sata T, Beck Y, Kitagawa Y, Kitajima M (2012) Indocyanine green injection for detecting sentinel nodes using color fluorescence camera in the laparoscopy-assisted gastrectomy. J Gastroenterol Hepatol 27(Suppl 3):29–33. CrossRefPubMedGoogle Scholar
  13. 13.
    Tonouchi H, Mohri Y, Tanaka K, Kobayashi M, Ohmori Y, Kusunoki M (2005) Laparoscopic lymphatic mapping and sentinel node biopsies for early-stage gastric cancer: the cause of false negativity. World J Surg 29(4):418–421. CrossRefPubMedGoogle Scholar
  14. 14.
    Iga AM, Robertson JH, Winslet MC, Seifalian AM (2007) Clinical potential of quantum dots. J Biomed Biotechnol 2007(10):76087. CrossRefPubMedGoogle Scholar
  15. 15.
    Kim S, Lim YT, Soltesz EG, De Grand AM, Lee J, Nakayama A, Parker JA, Mihaljevic T, Laurence RG, Dor DM, Cohn LH, Bawendi MG, Frangioni JV (2004) Near-infrared fluorescent type II quantum dots for sentinel lymph node mapping. Nat Biotechnol 22(1):93–97. CrossRefPubMedGoogle Scholar
  16. 16.
    Kong SH, Noh YW, Suh YS, Park HS, Lee HJ, Kang KW, Kim HC, Lim YT, Yang HK (2015) Evaluation of the novel near-infrared fluorescence tracers pullulan polymer nanogel and indocyanine green/gamma-glutamic acid complex for sentinel lymph node navigation surgery in large animal models. Gastric Cancer 18(1):55–64. CrossRefPubMedGoogle Scholar
  17. 17.
    Lee CM, Park S, Park SH, Jung SW, Choe JW, Sul JY, Jang YJ, Mok YJ, Kim JH (2016) Sentinel node mapping using a fluorescent dye and visible light during laparoscopic gastrectomy for early gastric cancer: result of a prospective study from a single institute. Ann Surg 265(4):766–773. CrossRefGoogle Scholar
  18. 18.
    Washington K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 17(12):3077–3079. CrossRefPubMedGoogle Scholar
  19. 19.
    Kang U, Berezin VB, Bae SJ, Kim SV (2011) Multispectral fluorescence organoscopes for in vivo studies of laboratory animals and their organs. J Opt Technol 78(9):82–90Google Scholar
  20. 20.
    Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20(1):1–19. CrossRefGoogle Scholar
  21. 21.
    Takeuchi H, Kitagawa Y (2015) Sentinel lymph node biopsy in gastric cancer. Cancer J 21(1):21–24. CrossRefPubMedGoogle Scholar
  22. 22.
    Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A (2003) Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 90(2):178–182. CrossRefPubMedGoogle Scholar
  23. 23.
    Hayashi H, Ochiai T, Mori M, Karube T, Suzuki T, Gunji Y, Hori S, Akutsu N, Matsubara H, Shimada H (2003) Sentinel lymph node mapping for gastric cancer using a dual procedure with dye—and gamma probe-guided techniques. J Am Coll Surg 196(1):68–74CrossRefPubMedGoogle Scholar
  24. 24.
    Kitagawa Y, Saikawa Y, Takeuchi H, Mukai M, Nakahara T, Kubo A, Kitajima M (2006) Sentinel node navigation in early stage gastric cancer: Updated data and current status. Scand J Surg 95(4):256–259. CrossRefPubMedGoogle Scholar
  25. 25.
    Park JY, Kim YW, Ryu KW, Nam BH, Lee YJ, Jeong SH, Park JH, Hur H, Han SU, Min JS, An JY, Hyung WJ, Cho GS, Jeong GA, Jeong O, Park YK, Jung MR, Yoon HM, Eom BW (2016) Assessment of laparoscopic stomach preserving surgery with sentinel basin dissection versus standard gastrectomy with lymphadenectomy in early gastric cancer: a multicenter randomized phase III clinical trial (SENORITA trial) protocol. BMC Cancer 16:340. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Meric-Bernstam F, Rasmussen JC, Krishnamurthy S, Tan I, Zhu B, Wagner JL, Babiera GV, Mittendorf EA, Sevick-Muraca EM (2013) Toward nodal staging of axillary lymph node basins through intradermal administration of fluorescent imaging agents. Biomed Opt Express 5(1):183–196. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgerySeoul National University Bundang HospitalSeongnamRepublic of Korea
  2. 2.Department of SurgerySeoul National University College of MedicineSeoulRepublic of Korea
  3. 3.Advanced Medical Device Research DivisionKorea Electrotechnology Research InstituteSeoulRepublic of Korea
  4. 4.Biomedical Research InstituteSeoul National University HospitalSeoulRepublic of Korea

Personalised recommendations