Son Gyung Mo, Kim Tae Un, Yun Mi Sook, Kim ChangYeop, Lee In Young, Park Su Bum, Shin Dong-Hoon, Ha Gi Won
Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea.
Cancers (Basel). 2024 Oct 16;16(20):3496. doi: 10.3390/cancers16203496.
BACKGROUND/OBJECTIVES: This study evaluated the impact of fluorescence lymph node mapping (FLNM) using indocyanine green (ICG) on the diagnostic accuracy of preoperative computed tomography (CT) in right-sided colon cancer.
A total of 218 patients who underwent laparoscopic right hemicolectomy with D3 lymph node dissection (LND) were analyzed: 86 patients in the FLNM group and 132 in the conventional surgery group. The FLNM technique allowed for enhanced intraoperative visualization of lymph node (LN) and more precise dissection, improving the identification of metastatic LNs. The diagnostic value of preoperative CT staging was assessed in both the FLNM and control groups by calculating the apparent prevalence, true prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value, positive likelihood ratio (PLR), negative likelihood ratio, false positive and false negative proportions, and accuracy.
FLNM increased the accuracy of CT staging for detecting D3 LN metastasis in advanced cancer cases, with a higher PPV, PLR, and accuracy. In the FLNM group, the false-positive rate was significantly reduced, and the specificity was higher compared to the control group. Multivariate analysis identified FLNM as an independent factor associated with improved D3 LN metastasis detection. These findings suggest that incorporating FLNM into surgical procedures enhances the diagnostic value of preoperative CT by improving the precision of LND, particularly in patients with advanced colon cancer.
The use of FLNM for D3 LND enhances the diagnostic accuracy of cN staging in right-sided colon cancer by improving surgical precision.
背景/目的：本研究评估了使用吲哚菁绿（ICG）进行荧光淋巴结 mapping（FLNM）对右侧结肠癌术前计算机断层扫描（CT）诊断准确性的影响。
共分析了 218 例行腹腔镜右半结肠切除术并进行 D3 淋巴结清扫（LND）的患者：FLNM 组 86 例，传统手术组 132 例。FLNM 技术可增强术中淋巴结（LN）的可视化并实现更精确的清扫，提高转移性 LN 的识别率。通过计算表观患病率、真实患病率、敏感性、特异性、阳性预测值（PPV）、阴性预测值、阳性似然比（PLR）、阴性似然比、假阳性和假阴性比例以及准确性，评估 FLNM 组和对照组术前 CT 分期的诊断价值。
FLNM 提高了晚期癌症病例中 CT 分期检测 D3 LN 转移的准确性，具有更高的 PPV、PLR 和准确性。在 FLNM 组中，假阳性率显著降低，与对照组相比特异性更高。多变量分析确定 FLNM 是与改善 D3 LN 转移检测相关的独立因素。这些发现表明，将 FLNM 纳入手术程序可通过提高 LND 的精确性来增强术前 CT 的诊断价值，特别是在晚期结肠癌患者中。
使用 FLNM 进行 D3 LND 通过提高手术精确性提高了右侧结肠癌 cN 分期的诊断准确性。
