Department of Gastrointestinal Tract Surgery, 108 Military Central Hospital, Hai Ba Trung District, Hanoi, Vietnam.
Department of Gastrointestinal Tract Surgery, 108 Military Central Hospital, Hai Ba Trung District, Hanoi, Vietnam.
J Gastrointest Surg. 2024 Jul;28(7):1078-1082. doi: 10.1016/j.gassur.2024.04.025. Epub 2024 May 3.
Evaluation of diagnostic value for lymph node (LN) metastasis and LN identification using indocyanine green (ICG) fluorescence in laparoscopic subtotal gastrectomy for gastric cancer.
A prospective study on 79 patients who underwent radical subtotal gastrectomy with the use of ICG-guided LN dissection. The sensitivity and specificity of the ICG fluorescence lymphography method in detecting metastatic LNs were evaluated.
A total of 79 patients underwent surgery. The number of LNs was retrieved: 2992 LNs, of which 2392 were fluorescent (79.9%) and 600 were nonfluorescent (20.1%). The average number of LNs dissected was 37.7 ± 11.8 LNs, and the average number of fluorescent LNs was 30.3 ± 11.1; the LN metastasis rates in the total LNs and in the ICG group were 6.79% and 7.34%, respectively. The median number of retrieved LNs in patients with LN metastases (37 [IQR, 33-47]) was higher than in patients without LN metastases (36 [IQR, 27-43]), (P = .348). The median number of fluorescent LNs was significantly higher in patients with LN metastases (32 [IQR, 26-44]) than in those without LN metastases (26 [IQR, 21-36]; P < .001). The sensitivity of ICG in metastasis detection was 75.86% (22 of 29 patients), with a false-negative rate of 24.14% (7 of 29 patients). For the identification of metastatic LNs, the sensitivity of ICG was 90.7%, with the specificity of 20.8%. The negative predictive value of nonfluorescent LNs was 97%.
ICG fluorescence lymphography-guided lymphadenectomy can clearly visualize the lymphatic system and the LNs alongside the tumor. The high sensitivity in detecting metastatic LNs and the high negative predictive value of a nonfluorescent LNs suggest that this is an effective method for clinically radical gastrectomy for gastric cancer.
评估腹腔镜胃癌根治性大部切除术中吲哚菁绿（ICG）荧光法对淋巴结（LN）转移和 LN 识别的诊断价值。
前瞻性研究 79 例行 ICG 引导 LN 解剖的根治性大部胃切除术患者。评估 ICG 荧光淋巴造影法检测转移性 LN 的敏感性和特异性。
共 79 例患者接受手术。共检出 LN 总数为 2992 枚，其中 2392 枚为荧光（79.9%），600 枚为非荧光（20.1%）。平均解剖 LN 数为 37.7±11.8 枚，平均荧光 LN 数为 30.3±11.1 枚；总 LN 及 ICG 组的 LN 转移率分别为 6.79%和 7.34%。LN 转移患者（37 [IQR，33-47]）的 LN 检出总数高于无 LN 转移患者（36 [IQR，27-43]）（P=0.348）。LN 转移患者（32 [IQR，26-44]）的荧光 LN 中位数明显高于无 LN 转移患者（26 [IQR，21-36]；P<0.001）。ICG 在转移检测中的敏感性为 75.86%（29 例患者中的 22 例），假阴性率为 24.14%（29 例患者中的 7 例）。对于转移性 LN 的识别，ICG 的敏感性为 90.7%，特异性为 20.8%。非荧光 LN 的阴性预测值为 97%。
ICG 荧光淋巴造影引导下的淋巴结清扫术可以清晰地显示淋巴管和肿瘤周围的淋巴结。对转移性 LN 的高敏感性和非荧光 LN 的高阴性预测值表明，这是一种有效的胃癌临床根治性胃切除术方法。
