Fagarasan Vlad, Bintintan Vasile V, Seicean Radu I, Fagarasan Giorgiana, Andras David, Botan Emil, Samasca Gabriel, Dindelegan George C, Cainap Calin I
1st Surgical Department, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj Napoca, Romania.
Department of Anatomy and Embriology, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Biomedicines. 2025 Apr 8;13(4):902. doi: 10.3390/biomedicines13040902.
Indocyanine green (ICG)-guided near-infrared (NIR) fluorescence imaging represents a potentially advantageous approach for the identification of lymphatic drainage pathways. This study was undertaken to evaluate the efficacy of ICG-guided NIR fluorescence in mapping lymphatic drainage and facilitating sentinel lymph node biopsy (SLNB) in patients diagnosed with colon cancer. A prospective cohort of 30 consecutive patients with colon cancer undergoing surgical resection at our institution was enrolled in this study. Peritumoral injection of ICG was performed to facilitate intraoperative identification of sentinel lymph nodes (SLNs). Identified SLNs were marked and excised ex vivo following specimen retrieval. All the retrieved specimens were submitted for histopathological analysis using hematoxylin and eosin (H&E) staining. SLNs that were negative for metastatic disease upon H&E staining underwent further examination via immunohistochemistry (IHC). Successful identification of SLNs was achieved in 83.33% of cases. The false positive rate was 6.6%, and the false negative rate was 8%, respectively. Atypical lymphatic drainage patterns were observed in 6.6% of the patients. Notably, the patients exhibiting atypical lymphatic drainage subsequently developed metastases during the follow-up period. Immunohistochemical analysis failed to detect micrometastases in SLNs that were initially deemed negative based on H&E staining. NIR-ICG fluorescence is a safe, reliable, and technically feasible method for performing SLNB in patients with colon cancer. Furthermore, this technique offers the potential for intraoperative identification of atypical lymphatic drainage pathways, which may have significant implications for determining the optimal extent of standard lymphadenectomy.
吲哚菁绿（ICG）引导的近红外（NIR）荧光成像代表了一种用于识别淋巴引流途径的潜在优势方法。本研究旨在评估ICG引导的NIR荧光在绘制结肠癌患者淋巴引流图谱及促进前哨淋巴结活检（SLNB）中的效果。本研究纳入了我院30例连续接受手术切除的结肠癌患者的前瞻性队列。在肿瘤周围注射ICG以促进术中识别前哨淋巴结（SLN）。识别出的SLN在标本取出后进行标记并离体切除。所有取出的标本均采用苏木精和伊红（H&E）染色进行组织病理学分析。H&E染色显示无转移疾病的SLN通过免疫组织化学（IHC）进行进一步检查。83.33%的病例成功识别出SLN。假阳性率分别为6.6%，假阴性率为8%。6.6%的患者观察到非典型淋巴引流模式。值得注意的是，表现出非典型淋巴引流的患者在随访期间随后发生了转移。免疫组织化学分析未能在最初基于H&E染色被认为阴性的SLN中检测到微转移。NIR-ICG荧光是一种在结肠癌患者中进行SLNB的安全、可靠且技术上可行的方法。此外，该技术为术中识别非典型淋巴引流途径提供了可能性，这可能对确定标准淋巴结清扫的最佳范围具有重要意义。
