Comparative study on the diagnostic value of intravenous/ peritumoral injection of indocyanine green for metastatic lymph node location in patients with head and neck squamous cell carcinoma (HNSCC)

Abstract

Background: Accurate assessment of regional lymph node (LN) status is essential for the treatment of head and neck squamous cell carcinoma (HNSCC) patients. In this study, we aimed to compare the difference between intravenous injection of indocyanine green (ICG) and peritumoral injection of ICG in the location of metastatic LNs.Methods: Twenty-nine patients were enrolled in this study with 13 patients receiving intravenous injection of ICG and 16 patients receiving peritumoral injection of ICG. During the surgery, the fluorescence-positive LNs in vivo were sent to undergo frozen section after fluorescence intensity was recorded. After the cervical LN dissection, all LNs were sorted by region, and the fluorescence intensity was recorded before the LNs were sent for paraffin section.Results: During the surgery, both intravenous or peritumoral injections with near-infrared (NIR) fluorescence imaging of ICG had their respective pros and cons in vivo, with the sensitivity and specificity being 62.5%/75% and 98.1%/89.1% respectively. After the surgery, both methods could reduce the pathological workload by preselecting the LNs at-risk in the premise of accurate assessing the cervical LN stage. However, intravenous ICG administration was more valuable in determining all types of LN status according to the fluorescence intensity [area under the curve (AUC): 0.91 vs. 0.78, P<0.001].Conclusions: With the assistance of NIR fluorescence imaging using ICG, both administration methods could reduce the postoperative complication and the pathological workload, whereas the intravenous mode of ICG administration is superior in application value.

Effect of radiation therapy on lymph node fluorescence in head and neck squamous cell carcinoma after intravenous injection of indocyanine green: A prospective evaluation

“…Recently, surgery has gained in popularity, exempli ed by Xia et al [7] who reported a sensitivity of 98.1% and speci city of 89.1% in the detection of metastatic nodes. In addition, a recent study [8] demonstrated the ability of ICG to identi ed neck metastases in a population of young adults and children with a sensitivity of 83%, a speci city of 88%, a positive predictive value (PPV) of 91%, and a negative predictive value (NPV) of 86%.…”

Near-Infrared Fluorescence Axillary Reverse Mapping (ARM) Procedure in Invasive Breast Cancer: Relationship between Fluorescence Signal in ARM Lymph Nodes and Clinical Outcomes

“…In the case of fluorescence signal in the lymph nodes after ALND, they proposed two hypotheses to explain ICG staining: fluorescent dye accumulation through the metastatic tumor tissues of the involved lymph nodes and dye loading in non-metastatic lymph nodes when in an inflammatory state [ 8 ]. Xia et al and Digonnet et al also measured the fluorescence signal intensity in SLN or cervical lymphadenectomy after intravenous or peritumoral ICG injection in head and neck cancer studies [ 9 , 35 ]. They reported a higher fluorescence signal in metastatic lymph nodes.…”

Application of Nano-Delivery Systems in Lymph Nodes for Tumor Immunotherapy

“…Intravenous administration mainly focuses on the diagnosis or treatment of tumor LNs metastasis [ 51 , 52 ]. For example, Xia [ 53 ] et al demonstrated the intravenous mode of indocyanine green (ICG) administration has a higher diagnostic value for localization of metastatic LNs than peritumoral injection in clinical samples of head and neck squamous cell carcinoma (HNSCC).…”