title: Intraoperative diagnosis using sentinel node biopsy with indocyanine green dye in gastric cancer surgery: an institutional trial by experienced surgeons.
abstract: BACKGROUND
  Reliable indicators that can intraoperatively determine the absence of nodal metastasis are in great demand to avoid unnecessary lymphadenectomy. However, little has been reported about the intraoperative diagnostic performance of sentinel node (SN) biopsy.
  
  
  METHODS
  Sentinel node biopsy by subserosal or submucosal injection of indocyanine green (ICG) was performed in 241 patients with American Joint Committee on Cancer tumor, node, metastasis staging system, 7th edition, clinical T1 (n = 190) and T2 (n = 51) gastric cancer by two experienced surgeons. All nodes that stained green (green node, GN), representing SNs, were excised before gastrectomy and were sliced into 2-mm sections for intraoperative histological examinations with hematoxylin and eosin staining. The sliced GNs were also examined simultaneously by imprint cytology.
  
  
  RESULTS
  The GNs were detectable in 240 patients (3.8 ± 2.4 nodes per patient; range 1-17 nodes; median 3 nodes), and the success rate of detection was 99.6 % (240 of 241). Of 240 patients with a successful detection, 29 were found to have lymph node (LN) metastases; 16 were diagnosed with LN metastases in both GNs and non-GNs, 12 in GNs alone, and 1 in non-GNs alone. The false-negative rate based on the SN concept was 3.4 % (1 of 29). However, two patients with cT1 gastric cancer were diagnosed as intraoperative GN negative but were later confirmed as GN positive by histological examinations of paraffin sections. As an intraoperative diagnosis, the false-negative rate was 10.3 % (3 of 29).
  
  
  CONCLUSIONS
  Sentinel node biopsy using ICG could be performed intraoperatively within reasonable limits under certain conditions, such as multiplanes for detection, combination use of imprint cytology, and open surgery by experienced surgeons.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. miyashir@biken.osaka-u.ac.jp
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hiratsuka
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Ko
authors.initials: K
authors.lastname: Takachi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Akemi
authors.initials: A
authors.lastname: Takenaka
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomita
authors.forename: Shingo
authors.initials: S
authors.lastname: Ishiguro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D025321:Surgery, Computer-Assisted
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green