Detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging: comparison with infrared imaging.
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.
Miyashiro
Isao
I
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. miyashir@biken.osaka-u.ac.jp
Miyoshi
Norikatsu
N
Hiratsuka
Masahiro
M
Kishi
Kentaro
K
Yamada
Terumasa
T
Ohue
Masayuki
M
Ohigashi
Hiroaki
H
Yano
Masahiko
M
Ishikawa
Osamu
O
Imaoka
Shingi
S
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D005743:Gastrectomy; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013055:Spectrophotometry, Infrared; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
D005456:Fluorescent Dyes; D007208:Indocyanine Green