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使用吲哚菁绿的近红外荧光成像进行淋巴引流图谱绘制,有助于在未接受新辅助化疗的食管癌或食管胃交界癌患者术中预测淋巴结转移。

Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy.

作者信息

Shiomi Shinichiro, Yagi Koichi, Iwata Ryohei, Yajima Shoh, Okumura Yasuhiro, Aikou Susumu, Yamashita Hiroharu, Nomura Sachiyo, Seto Yasuyuki

机构信息

Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

Division of Digestive Surgery, Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.

出版信息

Surg Endosc. 2023 Nov;37(11):8214-8226. doi: 10.1007/s00464-023-10368-4. Epub 2023 Aug 31.

DOI:10.1007/s00464-023-10368-4
PMID:37653159
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10615981/
Abstract

BACKGROUND

Lymphatic flow mapping using near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) has been used for the intraoperative prediction of lymph node metastasis in esophageal or esophagogastric junction cancer. However, a consistent method that yields sufficient diagnostic quality is yet to be confirmed. This study explored the diagnostic utility of our newly established lymphatic flow mapping protocol for predicting lymph node metastasis in patients with esophageal or esophagogastric junction cancer.

METHODS

We injected 0.5 mL of ICG (500 μg/mL) into the submucosal layer at four peritumoral points on the day before surgery for 54 patients. We performed lymphatic flow mapping intraoperatively using NIR imaging. After determining the NIR status and presence of metastases, evaluable lymph node stations on in vivo imaging and all resected lymph nodes were divided into four categories: ICG+meta+ (true positive), ICG+meta- (false positive), ICG-meta+ (false negative), and ICG-meta- (true negative).

RESULTS

The distribution of ICG+ and meta+ lymph node stations differed according to the primary tumor site. Sensitivity and specificity for predicting meta+ lymph nodes among ICG+ ones were 50% (95% CI 41-59%) and 75% (73-76%), respectively. Predicting meta+ lymph node stations among ICG+ stations improved these values to 66% (54-77%) and 77% (74-79%), respectively. Undergoing neoadjuvant chemotherapy was an independent risk factor for having meta+ lymph nodes with false-negative diagnoses (odds ratio 4.82; 95% CI 1.28-18.19). The sensitivity of our technique for predicting meta+ lymph nodes and meta+ lymph node stations in patients who did not undergo neoadjuvant chemotherapy was 79% (63-90%) and 83% (61-94%), respectively.

CONCLUSION

Our protocol potentially helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer undergoing esophagectomy who did not undergo neoadjuvant chemotherapy.

摘要

背景

使用吲哚菁绿(ICG)的近红外荧光(NIR)成像进行淋巴引流图谱绘制已用于术中预测食管癌或食管胃交界癌的淋巴结转移。然而,一种能产生足够诊断质量的一致方法尚未得到证实。本研究探讨了我们新建立的淋巴引流图谱方案在预测食管癌或食管胃交界癌患者淋巴结转移方面的诊断效用。

方法

在手术前一天,我们在54例患者的肿瘤周围四个点的黏膜下层注射0.5 mL ICG(500 μg/mL)。我们在术中使用NIR成像进行淋巴引流图谱绘制。在确定NIR状态和转移情况后,将体内成像上可评估的淋巴结站和所有切除的淋巴结分为四类:ICG+meta+(真阳性)、ICG+meta-(假阳性)、ICG-meta+(假阴性)和ICG-meta-(真阴性)。

结果

ICG+和meta+淋巴结站的分布因原发肿瘤部位而异。在ICG+的淋巴结中预测meta+淋巴结的敏感性和特异性分别为50%(95%CI 41-59%)和75%(73-76%)。在ICG+的淋巴结站中预测meta+淋巴结站可将这些值分别提高到66%(54-77%)和77%(74-79%)。接受新辅助化疗是出现假阴性诊断的meta+淋巴结的独立危险因素(比值比4.82;95%CI 1.28-18.19)。我们的技术在未接受新辅助化疗的患者中预测meta+淋巴结和meta+淋巴结站的敏感性分别为79%(63-90%)和83%(61-94%)。

结论

我们的方案可能有助于在未接受新辅助化疗的食管癌或食管胃交界癌患者行食管切除术时术中预测淋巴结转移。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/0ffa524395d4/464_2023_10368_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/ff1ab679db41/464_2023_10368_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/3a00c8eb32b5/464_2023_10368_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/d7397439d6f3/464_2023_10368_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/0ffa524395d4/464_2023_10368_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/ff1ab679db41/464_2023_10368_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/3a00c8eb32b5/464_2023_10368_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/d7397439d6f3/464_2023_10368_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4199/10615981/0ffa524395d4/464_2023_10368_Fig4_HTML.jpg

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