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Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Lymph node status is the most important prognostic factor in colon cancer, but the role of sentinel lymph node biopsy (SLNB) as a tool for identification of micrometastatic disease and extraanatomical lymph nodes for adjuvant strategies and a tailored approach still remains unclear. Indocyanine green (ICG) fluorescence detection is a new method for SLNB allowing real-time lymphography and lymph node detection. This study was designed to evaluate the feasibility of fluorescence-guided sentinel lymph node detection in colon carcinoma.

Methods

Twenty six patients with colon adenocarcinoma were prospectively included in this study. Intraoperatively, a peritumorous injection with a mean of 2.0 ml ICG was performed, followed by lymphatic mapping and SLNB. Clinical feasibility, detection rate, and sensitivity of the method were analyzed.

Results

No adverse reactions occurred due to the injection of ICG. Overall, ICG fluorescence imaging identified 1.7 sentinel lymph node (SLN) in average in 25 out of 26 patients (detection rate, 96%). Metastatic involvement of the SLN was found in nine out of 11 nodal positive patients by conventional histopathology. The sensitivity of the method was 82% for colon carcinoma, respectively.

Conclusion

ICG fluorescence imaging is a new, feasible method for SLNB of colon carcinoma and enables ultrastaging with improved accuracy but with limited validity due to the small number of cases. One advantage of this technique is real-time visualization of lymphatic vessels and SLNB without radiation exposure. Further, larger series are necessary to analyze the role of fluorescence-guided SLNB for colon cancer.

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Fig. 1

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Abbreviations

SLN:

Sentinel lymph node

ICG:

Indocyanine green

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Acknowledgments

This study was supported by grants of the HELIOS Research Center (HRC), Berlin, Germany and the Charite-Universitätsmedizin Berlin, Germany.

Conflict of interest statement

Mr. C. Hirche, Mrs. Z. Mohr, Mr. S. Kneif, Mr. S. Doniga, Mr. D. Murawa, Mr. M. Strik, and Mr. M. Hünerbein did not receive any support from industry which may be linked to this study, and no conflict of interest in participating in and publishing this study is declared.

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Authors and Affiliations

  1. Department of General Surgery and Surgical Oncology, Helios Hospital Berlin-Buch, 13122, Berlin, Germany

    Christoph Hirche, Zarah Mohr, Sören Kneif, Sergiu Doniga, Martin Strik & Michael Hünerbein

  2. Department for Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, The University of Heidelberg, Ludwig-Guttmann-Strasse 13, Ludwigshafen, Germany

    Christoph Hirche

  3. 1st Clinic of Surgical Oncology and General Surgery, Wielkopolska Cancer Centre, Garbary Street 15, 61-866, Poznań, Poland

    Dawid Murawa

Authors
  1. Christoph Hirche
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  2. Zarah Mohr
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  7. Michael Hünerbein
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Correspondence to Michael Hünerbein.

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Hirche, C., Mohr, Z., Kneif, S. et al. Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green. Int J Colorectal Dis 27, 319–324 (2012). https://doi.org/10.1007/s00384-011-1306-5

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  • DOI: https://doi.org/10.1007/s00384-011-1306-5

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