title: Sentinel node biopsy using indocyanine green in oral/oropharyngeal cancer.
abstract: BACKGROUND
  Radioactive tracer-based detection has been proposed as a standard procedure in identifying sentinel nodes for cN0 oral/oropharyngeal carcinoma. However, access to radioactive isotopes may be limited in some surgical centers, and there is potential risk of the radioactive tracers to the operators. This study was designed to evaluate the feasibility of near-infrared fluorescence imaging with indocyanine green combined with blue dye mapping in sentinel node biopsy for cN0 oral/oropharyngeal carcinoma.
  
  
  METHODS
  Twenty-six cases of previously untreated oral/oropharyngeal carcinoma staged cT1-2N0M0 were enrolled in this study. One milliliter of indocyanine green (5 mg/ml) and 1.5 ml of methylene blue (1 mg/ml) were injected sequentially around the primary tumor in a four-quadrant pattern before skin incision. After elevation of the platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were taken with a near-infrared detector, with special attention paid to any blue-dyed lymph nodes. Lymph nodes identified first with fluorescent hot spots with or without blue dye were defined as sentinel nodes, and they were harvested and sent for pathologic study.
  
  
  RESULTS
  Sentinel nodes were successfully harvested in all 26 cases. The number of sentinel nodes (SNs) per case varied from 1 to 9, with an average of 3.4. Routine pathology demonstrated occult metastasis exclusively in SNs in four cases (15.4 %). No tracer-associated side effects occurred in this series.
  
  
  CONCLUSIONS
  Near-infrared imaging using indocyanine green combined with methylene blue mapping is a feasible and reliable new method for SN biopsy in cN0 oral/oropharyngeal carcinoma.
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, Shantou City, Guangdong Province, 515031, China. penghanwei@126.com.
authors.forename: Hanwei
authors.initials: H
authors.lastname: Peng
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Wang
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, Shantou City, Guangdong Province, 515031, China.|Current address: Key Lab of Major Obstetrics Disease of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Niu
authors.affiliation: Department of Head and Neck Surgery, Cancer Hospital of Shantou University Medical College, No.7 Raoping Road, Shantou City, Guangdong Province, 515031, China.
authors.forename: Xihong
authors.initials: X
authors.lastname: Yang
authors.affiliation: Intelligent Medical Research Center, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
authors.forename: Chongwei
authors.initials: C
authors.lastname: Chi
authors.affiliation: Breast Cancer Center, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D011849:Radioactive Tracers; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D021701:Sentinel Lymph Node Biopsy
chemical_list: D004396:Coloring Agents; D011849:Radioactive Tracers; D019275:Radiopharmaceuticals; D007208:Indocyanine Green