title: Ultrastaging of colon cancer by sentinel node biopsy using fluorescence navigation with indocyanine green.
abstract: OBJECTIVE
  Lymph node status is the most important prognostic factor in colon cancer, but the role of sentinel lymph node biopsy (SLNB) as a tool for identification of micrometastatic disease and extraanatomical lymph nodes for adjuvant strategies and a tailored approach still remains unclear. Indocyanine green (ICG) fluorescence detection is a new method for SLNB allowing real-time lymphography and lymph node detection. This study was designed to evaluate the feasibility of fluorescence-guided sentinel lymph node detection in colon carcinoma.
  
  
  METHODS
  Twenty six patients with colon adenocarcinoma were prospectively included in this study. Intraoperatively, a peritumorous injection with a mean of 2.0 ml ICG was performed, followed by lymphatic mapping and SLNB. Clinical feasibility, detection rate, and sensitivity of the method were analyzed.
  
  
  RESULTS
  No adverse reactions occurred due to the injection of ICG. Overall, ICG fluorescence imaging identified 1.7 sentinel lymph node (SLN) in average in 25 out of 26 patients (detection rate, 96%). Metastatic involvement of the SLN was found in nine out of 11 nodal positive patients by conventional histopathology. The sensitivity of the method was 82% for colon carcinoma, respectively.
  
  
  CONCLUSIONS
  ICG fluorescence imaging is a new, feasible method for SLNB of colon carcinoma and enables ultrastaging with improved accuracy but with limited validity due to the small number of cases. One advantage of this technique is real-time visualization of lymphatic vessels and SLNB without radiation exposure. Further, larger series are necessary to analyze the role of fluorescence-guided SLNB for colon cancer.
authors.affiliation: Department of General Surgery and Surgical Oncology, Helios Hospital Berlin-Buch, 13122, Berlin, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hirche
authors.forename: Zarah
authors.initials: Z
authors.lastname: Mohr
authors.forename: Sören
authors.initials: S
authors.lastname: Kneif
authors.forename: Sergiu
authors.initials: S
authors.lastname: Doniga
authors.forename: Dawid
authors.initials: D
authors.lastname: Murawa
authors.forename: Martin
authors.initials: M
authors.lastname: Strik
authors.forename: Michael
authors.initials: M
authors.lastname: Hünerbein
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology*; D005188:False Negative Reactions; D005240:Feasibility Studies; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green / Q000009:adverse effects; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D061206:Neoplasm Micrometastasis / Q000175:diagnosis; D009367:Neoplasm Staging / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D013194:Staining and Labeling
chemical_list: D007208:Indocyanine Green