Chow Velda Ling-Yu, Ng Judy Chun-Wai, Chan Jimmy Yu-Wai, Gao Wei, Wong Thian-Sze
Division of Head and Neck Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
J Robot Surg. 2021 Jun;15(3):349-353. doi: 10.1007/s11701-020-01112-4. Epub 2020 Jun 27.
This study aims to assess the feasibility of using indocyanine green and robotic near infra-red fluorescent imaging (Firefly) for sentinel lymph node biopsy in cN0 oral cavity cancer. Ten patients with early squamous cell carcinoma of the tongue (n = 8) and buccal mucosa (n = 2) were included. Peritumoral injection of 10 mg indocyanine green and real-time mapping of sentinel lymph nodes in the neck was performed using Firefly via a retro-auricular trans-hairline incision. Sentinel lymph node was detected in all patients at 1.2 sentinel lymph node per person. Majority were situated in level II (91.7%). Mean time to detection of sentinel lymph node was 171.0 (68.0-312.0)s. Mean signal-to-background ratio was 5.62 (3.51-7.91). Frozen section of one sentinel lymph node was positive for malignancy, paraffin section of which confirmed the presence of metastatic disease. Modified radical neck dissection was performed for that particular patient, paraffin section of which did not show any tumor deposit. Frozen section and paraffin section of all other sentinel lymph nodes (n = 11) and neck dissection specimens yielded no malignancy. All resection margins were clear. Three patients completed adjuvant radiotherapy for pT2N0 (n = 2) and pT2N1 (n = 1) carcinoma of the tongue. Mean follow-up was 12.0 (4.0-18.0) months. All patients were alive at last follow-up with no disease recurrence. There were no adverse outcomes associated with the use of indocyanine green and robot-assisted neck dissection. Indocyanine green and Firefly for sentinel lymph node biopsy in cN0 oral cavity cancer is feasible with no adverse effects.
本研究旨在评估使用吲哚菁绿和机器人近红外荧光成像（萤火虫成像）进行cN0期口腔癌前哨淋巴结活检的可行性。纳入了10例早期舌鳞状细胞癌（n = 8）和颊黏膜癌（n = 2）患者。通过耳后经发际线切口，使用萤火虫成像对肿瘤周围注射10 mg吲哚菁绿，并对颈部前哨淋巴结进行实时定位。所有患者均检测到前哨淋巴结，人均1.2个前哨淋巴结。大多数位于Ⅱ区（91.7%）。检测到前哨淋巴结的平均时间为171.0（68.0 - 312.0）秒。平均信号与背景比为5.62（3.51 - 7.91）。1个前哨淋巴结的冰冻切片恶性肿瘤呈阳性，其石蜡切片证实存在转移性疾病。对该特定患者进行了改良根治性颈清扫术，其石蜡切片未显示任何肿瘤沉积物。所有其他前哨淋巴结（n = 11）和颈清扫标本的冰冻切片和石蜡切片均未发现恶性肿瘤。所有手术切缘均清晰。3例患者完成了针对pT2N0（n = 2）和pT2N1（n = 1）舌癌的辅助放疗。平均随访时间为12.0（4.0 - 18.0）个月。最后一次随访时所有患者均存活，无疾病复发。使用吲哚菁绿和机器人辅助颈清扫术未出现不良后果。吲哚菁绿和萤火虫成像用于cN0期口腔癌前哨淋巴结活检是可行的，且无不良反应。
