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Surgery Today
Published in: Surgery Today 6/2018

01-06-2018 | Original Article

Detection of alternative subpleural lymph flow pathways using indocyanine green fluorescence

Authors: Aya Harada Takeda, Yui Watanabe, Toshiyuki Nagata, Masaya Aoki, Tadashi Umehara, Soichi Suzuki, Go Kamimura, Kazuhiro Wakida, Tsunayuki Otsuka, Naoya Yokomakura, Kota Kariatsumari, Koichi Sakasegawa, Yoshihiro Nakamura, Masami Sato

Published in: Surgery Today | Issue 6/2018

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Abstract

Purpose

Pulmonary lymphatic fluid predominately flows along the bronchi. However, there are reports suggesting that an alternative lymphatic pathway exist, which may result in skip metastases. The aim of this study was to evaluate the subpleural lymph flow in vivo using indocyanine green (ICG) fluorescence.

Methods

One hundred cases were enrolled. ICG was injected into the macroscopically healthy subpleural space. Intraoperative fluorescence images were then observed in real time.

Results

ICG fluorescence was observed moving through subpleural channels in 58/100 cases. ICG flowed into adjacent lobes over interlobar lines in 18 cases and flowed from the visceral pleura directly into the mediastinum in 5 cases. The frequency of mediastinal detection without hilar lymph node detection was significantly higher in the left lung compared to the right (p < 0.05). The subpleural lymph flow detection rates were significantly lower in patients with smoking pack-years ≥ 40 than those with < 40 (p < 0.05).

Conclusions

The flow of lymphatic fluid directly into the mediastinum suggests one mechanism of skip metastasis. In addition, the reduction of the subpleural lymph flows in smokers with ≥ 40 pack-years suggests that smoking might modify lymph flow patterns. These findings may assist in selecting the optimal therapy for patients with possible skip metastasis.
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Metadata
Title
Detection of alternative subpleural lymph flow pathways using indocyanine green fluorescence
Authors
Aya Harada Takeda
Yui Watanabe
Toshiyuki Nagata
Masaya Aoki
Tadashi Umehara
Soichi Suzuki
Go Kamimura
Kazuhiro Wakida
Tsunayuki Otsuka
Naoya Yokomakura
Kota Kariatsumari
Koichi Sakasegawa
Yoshihiro Nakamura
Masami Sato
Publication date
01-06-2018
Publisher
Springer Singapore
Published in
Surgery Today / Issue 6/2018
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-018-1631-1

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