title: Laparoscopic sentinel lymph node identification in patients with colon carcinoma using a near-infrared dye: description of a new technique and feasibility study.
abstract: BACKGROUND
  After promising results were obtained from studies in large animals, a technique using indocyanine green (ICG) is being introduced for sentinel lymph node (SLN) biopsy in colon cancer patients.
  
  
  METHODS
  Colon cancer patients without clinical signs of metastatic disease, presenting at the VU University Medical Center (Amsterdam, The Netherlands) or Kennemer Gasthuis (Haarlem, The Netherlands), were asked to participate in the study. During laparoscopy, a subserosal injection of 2.5 mg of ICG diluted in 1 mL of 0.9% NaCl plus 2% human albumin was performed using a percutaneously inserted long rigid or flexible needle. After injection, a near-infrared laparoscope (Olympus Corp., Tokyo, Japan) was used for lymph flow and SLN visualization. The SLNs were laparoscopically harvested and analyzed by a senior pathologist using multisectioning and immunohistochemistry.
  
  
  RESULTS
  Fourteen patients were included (six women, eight men), with a median age of 75.5 (interquartile range [IQR], 67.8-81.0) years and a median body mass index of 25.1 (IQR, 22.7-26.0) kg/m(2). Median tumor diameter was 4.5 (IQR, 3.4-7.0) cm. At least one SLN was identified in all patients, with a median number of 2.0 (IQR, 2.0-3.3) SLNs. The median time between injection and identification of the SLN was 15.0 (IQR, 13.3-29.3) minutes. Positioning of the needle tip into the subserosal layer was found to be more effective using the flexible needle. When this flexible needle was used, less spill of dye was observed. All SLNs were negative. We observed four false-negative nodes, all after using a rigid needle. None of the patients showed an adverse reaction to the ICG injection.
  
  
  CONCLUSIONS
  Preliminary results of laparoscopic sentinel node identification using a near-infrared dye show this procedure is safe and feasible. It was possible to detect lymph nodes in all patients. Large tumor size, drainage to adjacent lymphatic vessels, and the use of a rigid needle might contribute to false-negative nodes.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. m.pas@vumc.nl
authors.forename: Martijn H G M
authors.initials: MH
authors.lastname: van der Pas
authors.forename: Marjolein
authors.initials: M
authors.lastname: Ankersmit
authors.forename: Hein B A C
authors.initials: HB
authors.lastname: Stockmann
authors.forename: Rob
authors.initials: R
authors.lastname: Silvis
authors.forename: Nicole C T
authors.initials: NC
authors.lastname: van Grieken
authors.forename: Herman
authors.initials: H
authors.lastname: Bril
authors.forename: Wilhelmus J H J
authors.initials: WJ
authors.lastname: Meijerink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology*; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007259:Infrared Rays; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*
chemical_list: D004396:Coloring Agents