title: Near-infrared fluorescence sentinel lymph node detection in gastric cancer: A pilot study.
abstract: OBJECTIVE
  To investigate feasibility and accuracy of near-infrared fluorescence imaging using indocyanine green: nanocolloid for sentinel lymph node (SLN) detection in gastric cancer.
  
  
  METHODS
  A prospective, single-institution, phase I feasibility trial was conducted. Patients suffering from gastric cancer and planned for gastrectomy were included. During surgery, a subserosal injection of 1.6 mL ICG:Nanocoll was administered around the tumor. NIR fluorescence imaging of the abdominal cavity was performed using the Mini-FLARE™ NIR fluorescence imaging system. Lymphatic pathways and SLNs were visualized. Of every detected SLN, the corresponding lymph node station, signal-to-background ratio and histopathological diagnosis was determined. Patients underwent standard-of-care gastrectomy. Detected SLNs outside the standard dissection planes were also resected and evaluated.
  
  
  RESULTS
  Twenty-six patients were enrolled. Four patients were excluded because distant metastases were found during surgery or due to technical failure of the injection. In 21 of the remaining 22 patients, at least 1 SLN was detected by NIR Fluorescence imaging (mean 3.1 SLNs; range 1-6). In 8 of the 21 patients, tumor-positive LNs were found. Overall accuracy of the technique was 90% (70%-99%; 95%CI), which decreased by higher pT-stage (100%, 100%, 100%, 90%, 0% for respectively Tx, T1, T2, T3, T4 tumors). All NIR-negative SLNs were completely effaced by tumor. Mean fluorescence signal-to-background ratio of SLNs was 4.4 (range 1.4-19.8). In 8 of the 21 patients, SLNs outside the standard resection plane were identified, that contained malignant cells in 2 patients.
  
  
  CONCLUSIONS
  This study shows successful use of ICG:Nanocoll as lymphatic tracer for SLN detection in gastric cancer. Moreover, tumor-containing LNs outside the standard dissection planes were identified.
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Quirijn R J G
authors.initials: QR
authors.lastname: Tummers
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Leonora S F
authors.initials: LS
authors.lastname: Boogerd
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Wobbe O
authors.initials: WO
authors.lastname: de Steur
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Floris P R
authors.initials: FP
authors.lastname: Verbeek
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Boonstra
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Henricus J M
authors.initials: HJ
authors.lastname: Handgraaf
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: John V
authors.initials: JV
authors.lastname: Frangioni
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Henk H
authors.initials: HH
authors.lastname: Hartgrink
authors.affiliation: Quirijn RJG Tummers, Leonora SF Boogerd, Wobbe O de Steur, Floris PR Verbeek, Martin C Boonstra, Henricus JM Handgraaf, Cornelis JH van de Velde, Henk H Hartgrink, Alexander L Vahrmeijer, Department of Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Vahrmeijer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D005743:Gastrectomy; D006801:Humans; D007208:Indocyanine Green; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D019265:Spectroscopy, Near-Infrared; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green
keywords: Gastric cancer; Image-guided surgery; Indocyanine green; Near-infrared fluorescence imaging; Sentinel lymph node