Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary.
Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary.
Pathol Oncol Res. 2024 Aug 29;30:1611853. doi: 10.3389/pore.2024.1611853. eCollection 2024.
Accurate lymph node (LN) retrieval during colorectal carcinoma resection is pivotal for precise N-staging and the determination of adjuvant therapy. Current guidelines recommend the examination of at least 12 mesocolic or mesorectal lymph nodes for accurate staging. Traditional histological processing techniques, reliant on visual inspection and palpation, are time-consuming and heavily dependent on the examiner's expertise and availability. Various methods have been documented to enhance LN retrieval from colorectal specimens, including intra-arterial methylene blue injection. Recent studies have explored the utility of indocyanine green (ICG) fluorescence imaging for visualizing pericolic lymph nodes and identifying sentinel lymph nodes in colorectal malignancies. This study included 10 patients who underwent colon resection for malignant tumors. During surgery, intravenous ICG dye and an endoscopic camera were employed to assess intestinal perfusion. Post-resection, intra-arterial administration of ICG dye was performed on the specimens, followed by routine histological processing and an ICG-assisted lymph node dissection. The objective was to evaluate whether ICG imaging could identify additional lymph nodes compared to routine manual dissection and to assess the clinical relevance of these findings. For each patient, a minimum of 12 lymph nodes (median = 25.5, interquartile range = 12.25, maximum = 33) were examined. ICG imaging facilitated the detection of a median of three additional lymph nodes not identified during routine processing. Metastatic lymph nodes were found in four patients however no additional metastatic nodes were detected with ICG assistance. Our findings suggest that intra-arterial administration of indocyanine green dye can augment lymph node dissection, particularly in cases where the number of lymph nodes retrieved is below the recommended threshold of 12.
在结直肠癌切除术期间准确地获取淋巴结 (LN) 对于精确的 N 分期和辅助治疗的确定至关重要。目前的指南建议至少检查 12 个结肠系膜或中直肠淋巴结以进行准确的分期。传统的组织学处理技术依赖于目视检查和触诊，既费时又严重依赖于检查者的专业知识和可用性。已经记录了各种方法来增强从结直肠标本中获取淋巴结的能力，包括动脉内亚甲蓝注射。最近的研究探讨了使用吲哚菁绿 (ICG) 荧光成像来可视化结肠旁淋巴结和识别结直肠恶性肿瘤中的前哨淋巴结的效用。这项研究包括 10 名因恶性肿瘤而行结肠切除术的患者。手术期间，静脉内注射 ICG 染料和内镜摄像机用于评估肠道灌注。切除后，对标本进行动脉内 ICG 染料给药，然后进行常规组织学处理和 ICG 辅助的淋巴结清扫。目的是评估 ICG 成像是否能比常规手动解剖识别更多的淋巴结，并评估这些发现的临床相关性。对于每个患者，检查了至少 12 个淋巴结（中位数=25.5，四分位距=12.25，最大值=33）。ICG 成像有助于发现常规处理过程中未识别的中位数为 3 个额外的淋巴结。在 4 名患者中发现了转移性淋巴结，但未在 ICG 辅助下发现额外的转移性淋巴结。我们的研究结果表明，动脉内给予吲哚菁绿染料可以增强淋巴结清扫，特别是在获取的淋巴结数量低于推荐的 12 个阈值的情况下。
