Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Molecular Frontier Surgery, Course of Advanced Therapeutics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Gastric Cancer. 2018 Sep;21(5):776-781. doi: 10.1007/s10120-018-0816-z. Epub 2018 Mar 7.
The sentinel node (SN) detection by dual tracer method using indocyanine green (ICG) and a radioisotope (RI) has been recommended for early gastric cancer. However, institutions are limited due to radioactivity in the RI method. The greatest advantage of the RI method is that it objectively assesses RI uptake as a numerical value. The aim of the present study was to verify the usefulness of ICG fluorescence intensity in SN.
Seventeen patients with early gastric cancer were enrolled in this study. RI uptake by each lymph node was measured using Navigator GPS and fluorescence nodes were identified using the hyper eye medical system (HEMS). Fluorescence intensity in fluorescence nodes was evaluated using ICG intensity imaging software (Mizuho, Japan) of the HEMS.
The total number of dissected lymph nodes was 227, with an average of 13.3 per patient. The numbers of HN, FN-S, and FN-B were 64, 77, and 34. RI uptake was significantly greater by FN-S than by non-FN-S (P = 0.0016). The median fluorescence intensity value was higher in HN than in non-HN (P < 0.001). A correlation was observed between RI uptake and fluorescence intensity. Dissecting FNs with fluorescence intensity levels of 1-6 resulted in 92.1% dissection of HNs.
It is possible that the evaluation of fluorescence intensity is useful for selected SNs instead of RI tracer. If fluorescence intensity is measurable in surgery, an infrared fluorescence method using ICG may be useful and safe for the detection of SN in early gastric cancer.
使用吲哚菁绿（ICG）和放射性同位素（RI）的双示踪剂法检测前哨淋巴结（SN）已被推荐用于早期胃癌。然而，由于 RI 方法具有放射性，机构受到限制。RI 方法的最大优势在于它可以客观地评估 RI 摄取作为数值。本研究的目的是验证 SN 中 ICG 荧光强度的有用性。
本研究纳入了 17 例早期胃癌患者。使用 Navigator GPS 测量每个淋巴结的 RI 摄取量，并使用 Hyper Eye Medical System（HEMS）识别荧光节点。使用 HEMS 的 ICG 强度成像软件（日本瑞穗）评估荧光节点中的荧光强度。
共解剖 227 个淋巴结，平均每个患者 13.3 个。HN、FN-S 和 FN-B 的数量分别为 64、77 和 34。FN-S 的 RI 摄取量明显大于非 FN-S（P=0.0016）。HN 的荧光强度中位数高于非 HN（P<0.001）。RI 摄取量与荧光强度之间存在相关性。解剖荧光强度为 1-6 的 FNs 可使 92.1%的 HN 被解剖。
评估荧光强度可能有助于选择 SN，而无需 RI 示踪剂。如果在手术中可以测量荧光强度，则使用 ICG 的红外荧光法可能对检测早期胃癌的 SN 既有用又安全。
