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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2020

01-10-2020 | Metastasis | Thoracic Oncology

Near-Infrared Fluorescent Image-Guided Lymphatic Mapping in Esophageal Squamous Cell Carcinoma

Authors: Haoyao Jiang, MD, Haohua Teng, MD, Yifeng Sun, MD, PhD, Xufeng Guo, MD, PhD, Rong Hua, MD, PhD, Yuchen Su, MD, Bin Li, MD, PhD, Bo Ye, MD, PhD, Yu Yang, MD, Zhigang Li, MD, PhD

Published in: Annals of Surgical Oncology | Issue 10/2020

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Abstract

Background

Recently, the feasibility of near-infrared (NIR) image-guided sentinel lymph node (SLN) mapping has been tested in patients with gastrointestinal cancer. The aim of this study is to investigate whether SLN mapping can be used to identify mediastinal lymph node metastases during minimally invasive esophagectomy and explore the lymphatic drainage pattern of esophageal squamous cell carcinoma (ESCC) using NIR fluorescent imaging.

Patients and Methods

A total of 21 patients diagnosed with cT1–3 stage ESCC were enrolled. Patients received submucosal injection of indocyanine green diluted with sodium chloride (0.9%) at the start of the esophagectomy procedure followed by NIR mapping.

Results

Thoracoscopic-assisted McKeown esophagectomy with NIR imaging was successfully performed in all patients. The detection rate and number of NIR+ lymph nodes were 95.2% (20/21) and 4.0 (2.0–6.5), respectively. The accuracy, false-negative rates, and negative predictive value were 100% (10 of 10 cases), 0% (0 of 4), and 100% (6 of 6), respectively, for pT1/T2 diseases; and 80.0% (8 of 10), 40% (2 of 5), and 71.4% (5 of 7), respectively, for pT3 diseases. The NIR+ region was the most commonly detected in the right recurrent laryngeal nerve (80%), and the NIR+ region was identified in the upper mediastinal zone in 20 patients.

Conclusions

Evaluation of the lymphatic drainage pattern and the application of sentinel lymph node in ESCC with real-time NIR imaging could be effective, especially in pT1/2 disease. NIR imaging-guided SLN navigation appears to be a clinically beneficial less-invasive method for treating ESCC.
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Metadata
Title
Near-Infrared Fluorescent Image-Guided Lymphatic Mapping in Esophageal Squamous Cell Carcinoma
Authors
Haoyao Jiang, MD
Haohua Teng, MD
Yifeng Sun, MD, PhD
Xufeng Guo, MD, PhD
Rong Hua, MD, PhD
Yuchen Su, MD
Bin Li, MD, PhD
Bo Ye, MD, PhD
Yu Yang, MD
Zhigang Li, MD, PhD
Publication date
01-10-2020
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2020
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07969-6

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