Staniloaie Daniel, Budin Constantin, Ilco Alexandru, Vasile Danut, Calinoiu Amalia Loredana, Rusu Adina, Iancu George, Ammar Tarek, Georgescu Cristian Florin, Tanasescu Maria-Daniela, Minca Alexandru, Georgescu Dragos Eugen
"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
First General Surgery Department, Emergency University Hospital, Bucharest, Romania.
Maedica (Bucur). 2022 Jun;17(2):264-270. doi: 10.26574/maedica.2022.17.2.264.
The indocyanine green fluorescence imaging system allows the identification of lymphatic vessels, lymph nodes and blood flow during surgery. Colorectal cancer is the second commonest cancer in women, the third in men, being the fourth commonest cause of cancer death. One of the most important factors for staging and prognosis in colorectal cancer is the involvement of the regional lymph nodes. In the literature, there are several methods for identifying sentinel lymph nodes, including methylene blue, technetium (99m Tc) and indocyanine green. The current article presents the use of indocyanate in the identification of sentinel node/nodes in malignant tumors of the colon, by a technique performed in vivo, before the primary ligation of the vascular pedicles. The study was prospectively conducted on a group of 23 patients who had undergone a standard surgical resection - 21 of them for a malignant tumor of the colon and two patients for a malignant rectal tumor - in the 1st General Surgery Department, Emergency University Hospital, Bucharest, Romania, between January 2020-March 2022. During surgery, sentinel lymph node detection was performed using indocyanine green and the Karl Storz® Vitom ICG probe. Sentinel lymph nodes were separately excised and sent to the Department of Pathological Anatomy for analysis. Sentinel nodes were successfully identified in 13 patients and the overall identification rate was 56.52% (13/23 cases). In seven cases, the number of invaded nodes was the same as that of identified and invaded sentinel nodes. Complete lymphadenectomy was performed in all cases regardless of the staining status of the sentinel lymph nodes. The use of fluorescence imaging with indocyanine green in colorectal cancer remains controversial. Since no specific receptor target is used, the fluorescent signal is not specific for lymph node metastases. The learning curve is particularly important for increasing the accuracy of the technique and is responsible for the negative results in some cases. Cases in which lymph nodes have not been invaded require further evaluation through immunohistochemistry and chain polymerization reaction (RT-PCR).
吲哚菁绿荧光成像系统可在手术过程中识别淋巴管、淋巴结和血流情况。结直肠癌是女性中第二常见的癌症，男性中第三常见，是癌症死亡的第四大常见原因。区域淋巴结受累是结直肠癌分期和预后的最重要因素之一。文献中有多种识别前哨淋巴结的方法，包括亚甲蓝、锝（99m Tc）和吲哚菁绿。本文介绍了在血管蒂初次结扎前通过体内技术使用吲哚菁绿识别结肠恶性肿瘤前哨淋巴结的方法。该研究前瞻性地纳入了23例接受标准手术切除的患者，其中21例为结肠恶性肿瘤，2例为直肠恶性肿瘤，研究于2020年1月至2022年3月在罗马尼亚布加勒斯特急诊大学医院第一普通外科进行。手术过程中，使用吲哚菁绿和卡尔·史托斯®Vitom ICG探头进行前哨淋巴结检测。前哨淋巴结被单独切除并送至病理解剖科进行分析。13例患者成功识别出前哨淋巴结，总体识别率为56.52%（13/23例）。7例中，受累淋巴结数量与识别并受累的前哨淋巴结数量相同。无论前哨淋巴结的染色情况如何，所有病例均进行了完整的淋巴结清扫术。在结直肠癌中使用吲哚菁绿荧光成像仍存在争议。由于未使用特定的受体靶点，荧光信号对淋巴结转移不具有特异性。学习曲线对于提高该技术的准确性尤为重要，并且是某些情况下出现阴性结果的原因。未受累淋巴结的病例需要通过免疫组织化学和链聚合反应（RT-PCR）进行进一步评估。
