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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2012

01-02-2012 | Gastrointestinal Oncology

Sentinel Lymph Node Biopsy Using Intraoperative Indocyanine Green Fluorescence Imaging Navigated with Preoperative CT Lymphography for Superficial Esophageal Cancer

Authors: Yasuhiro Yuasa, MD, Junichi Seike, MD, Takahiro Yoshida, MD, PhD, Hirokazu Takechi, MD, Hiromichi Yamai, MD, PhD, Yota Yamamoto, MD, Yoshihito Furukita, MD, Masakazu Goto, MD, Takuya Minato, MD, Takeshi Nishino, MD, Seiya Inoue, MD, Satoshi Fujiwara, MD, Akira Tangoku, MD, PhD

Published in: Annals of Surgical Oncology | Issue 2/2012

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Abstract

Background

The sentinel lymph node (SLN) concept has been gaining attention for gastrointestinal neoplasms but remains controversial for esophageal cancer. This study evaluated the feasibility of SLN identification using intraoperative indocyanine green (ICG) fluorescence imaging (IGFI) navigated by preoperative computed tomographic lymphography (CTLG) to treat superficial esophageal cancer.

Methods

Subjects comprised 20 patients clinically diagnosed with superficial esophageal cancer. Five minutes after endoscopic submucosal injection of iopamidol around the primary lesion using a four-quadrant injection pattern with a 23-gauge endoscopic injection sclerotherapy needle, three-dimensional multidetector computed tomography was performed to identify SLNs and lymphatic routes. ICG solution was injected intraoperatively around the tumor. Fluorescence imaging was obtained by infrared ray electronic endoscopy. Thoracoscope-assisted standard radical esophagectomy with lymphadenectomy was performed to confirm fluorescent lymph nodes detected by CTLG.

Results

Lymphatic vessels and SLNs were identified preoperatively using CTLG in all cases. Intraoperative detection rates were 100% using CTLG and 95% using IGFI. Lymph node metastases were found in four cases, including one false-negative case with SLNs occupied by bulky metastatic tumor that were not enhanced with both methods. The other 19 cases, including three cases of metastatic lymph nodes, were accurately identified by both procedures.

Conclusions

Preoperative CTLG visualized the correct number and site of SLNs in surrounding anatomy during routine computed tomography to evaluate distant metastases. Referring to CTLG, SLNs were identified using IGFI, resulting in successful SLN navigation and saving time and cost. This method appears clinically applicable as a less-invasive method for treating superficial esophageal cancer.
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Metadata
Title
Sentinel Lymph Node Biopsy Using Intraoperative Indocyanine Green Fluorescence Imaging Navigated with Preoperative CT Lymphography for Superficial Esophageal Cancer
Authors
Yasuhiro Yuasa, MD
Junichi Seike, MD
Takahiro Yoshida, MD, PhD
Hirokazu Takechi, MD
Hiromichi Yamai, MD, PhD
Yota Yamamoto, MD
Yoshihito Furukita, MD
Masakazu Goto, MD
Takuya Minato, MD
Takeshi Nishino, MD
Seiya Inoue, MD
Satoshi Fujiwara, MD
Akira Tangoku, MD, PhD
Publication date
01-02-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-011-1922-x

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