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Detection of Sentinel Node in Gastric Cancer Surgery by Indocyanine Green Fluorescence Imaging: Comparison with Infrared Imaging

Annals of Surgical Oncology volume 15, pages 1640–1643 (2008)Cite this article

Abstract

Background

Secure methods for clinical detection of the sentinel node (SN) are in great demand to avoid unnecessary resection. This was a clinical exploration/feasibility study of a novel detection system for SN biopsy using indocyanine green (ICG) fluorescence imaging in gastric cancer surgery.

Methods

SN biopsy using ICG dye was performed in three patients who had gastric cancer. ICG fluorescence images were obtained using a detection system comprising a charge-coupled device (CCD) camera with a cut filter as the detector and light emitting diodes (LED) as the light source. The nodes were also examined simultaneously by an infrared (IR) imaging videoscope.

Results

Immediately after intraoperative ICG injection, the fluorescence imaging system allowed easy visualization of the lymphatic vessels draining from the primary gastric tumor toward the lymph nodes and tracing of the moving injected dye. Some lymph vessels and nodes were hardly recognized by ICG green color or IR imaging. The ICG fluorescence system also allowed visualization of the lymph node when ICG was injected the day before surgery, similar to the radio-guided method.

Conclusions

Detection of SNs in gastric cancer surgery using the ICG fluorescence imaging system is a promising novel technique and may perhaps prove useful for laparoscopic surgery.

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References

  1. Giuliano AE, Kirgan DM, Guenther JM, et al. Lymphatic mapping, sentinel lymphadenectomy for breast cancer. Ann Surg 1994; 220:391–8

    PubMed  Article  CAS  Google Scholar 

  2. Krag DN, Weaver DL, Alex JC, et al. Surgical resection and radiolocalization of the sentinel lymph node in breast cancer using a gamma probe. Surg Oncol 1993; 2:335–9

    PubMed  Article  CAS  Google Scholar 

  3. Morton DL, Wen DR, Wong JH, et al. Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992; 127:392–9

    PubMed  CAS  Google Scholar 

  4. Hiratsuka M, Miyashiro I, Ishikawa O, et al. Application of sentinel node biopsy to gastric cancer surgery. Surgery 2001; 129:335–40

    PubMed  Article  CAS  Google Scholar 

  5. Bostick P, Essner R, Glass E, et al. Comparison of blue dye and probe-assisted intraoperative lymphatic mapping in melanoma to identify sentinel nodes in 100 lymphatic basins. Arch Surg 1999; 134:43–9

    PubMed  Article  CAS  Google Scholar 

  6. Giuliano AE, Jones RC, Brennan M, et al. Sentinel lymphadenectomy in breast cancer. J Clin Oncol 1997; 15:2345–50

    PubMed  CAS  Google Scholar 

  7. Morrow M, Rademaker AW, Bethke KP, et al. Learning sentinel node biopsy: results of a prospective randomized trial of two techniques. Surgery 1999; 126:714–20

    PubMed  CAS  Google Scholar 

  8. Sanidas EE, de Bree E, Tsiftsis DD. How many cases are enough for accreditation in sentinel lymph node biopsy in breast cancer? Am J Surg 2003; 185:202–10

    PubMed  Article  Google Scholar 

  9. Cox CE, Salud CJ, Cantor A, et al. Learning curves for breast cancer sentinel lymph node mapping based on surgical volume analysis. J Am Coll Surg 2001; 193:593–600

    PubMed  Article  CAS  Google Scholar 

  10. Kitai T, Inomoto T, Miwa M, et al. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer 2005; 12:211–5

    PubMed  Article  Google Scholar 

  11. Ishikawa K, Yasuda K, Shiromizu A, et al. Laparoscopic sentinel node navigation achieved by infrared ray electronic endoscopy system in patients with gastric cancer. Surg Endosc 2007; 21:1131–4

    PubMed  Article  CAS  Google Scholar 

  12. 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

    PubMed  Article  CAS  Google Scholar 

  13. Japanese Gastric Cancer A. Japanese classification of gastric carcinoma—2nd english edition Gastric Cancer 1998; 1:10–24

    Google Scholar 

  14. Caesar J, Shaldon S, Chiandussi L, et al. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci 1961; 21:43–57

    PubMed  CAS  Google Scholar 

  15. Takayama S, Furuhama K, Ohura K, et al. Experimental studies on the usefulness of indocyanine green (ICG) as a lymphatic vital dye (in Japanese). Oyo Yakuri / Pharmacometrics 1980; 19:603–14

    Google Scholar 

  16. Cimmino VM, Brown AC, Szocik JF, et al. Allergic reactions to isosulfan blue during sentinel node biopsy–a common event. Surgery 2001; 130:439–42

    PubMed  Article  CAS  Google Scholar 

  17. Kitagawa Y, Fujii H, Mukai M, et al. Current status and future prospects of sentinel node navigational surgery for gastrointestinal cancers. Ann Surg Oncol 2004; 11:242S–4S

    PubMed  Google Scholar 

  18. Tonouchi H, Mohri Y, Tanaka K, et al. Laparoscopic lymphatic mapping and sentinel node biopsies for early-stage gastric cancer: the cause of false negativity. World J Surg 2005; 29:418–21

    PubMed  Article  Google Scholar 

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Acknowledgment

This study was supported in part by the Otsuka Grant.

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Affiliations

  1. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511, Japan

    Isao Miyashiro MD, Norikatsu Miyoshi MD, Kentaro Kishi MD, Terumasa Yamada MD, Masayuki Ohue MD, Hiroaki Ohigashi MD, Masahiko Yano MD, Osamu Ishikawa MD & Shingi Imaoka MD

  2. Department of Surgery, Itami Municipal Hospital, 1-100 Koyaike, Itami, Hyogo, 664-0015, Japan

    Masahiro Hiratsuka MD

Authors
  1. Isao Miyashiro MD
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  2. Norikatsu Miyoshi MD
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  3. Masahiro Hiratsuka MD
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  4. Kentaro Kishi MD
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  5. Terumasa Yamada MD
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  6. Masayuki Ohue MD
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  7. Hiroaki Ohigashi MD
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  8. Masahiko Yano MD
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  9. Osamu Ishikawa MD
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  10. Shingi Imaoka MD
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Corresponding author

Correspondence to Isao Miyashiro MD.

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Miyashiro, I., Miyoshi, N., Hiratsuka, M. et al. Detection of Sentinel Node in Gastric Cancer Surgery by Indocyanine Green Fluorescence Imaging: Comparison with Infrared Imaging. Ann Surg Oncol 15, 1640–1643 (2008). https://doi.org/10.1245/s10434-008-9872-7

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  • DOI: https://doi.org/10.1245/s10434-008-9872-7

Keywords

  • Sentinel node
  • Gastric cancer
  • Indocyanine green fluorescence imaging
  • Light emitting diode (LED)
  • Infrared (IR) imaging