In vivo and ex vivo sentinel node mapping does not identify the same lymph nodes in colon cancer

Abstract

Placing a deposit in relation to the tumor by indocyanine green in vivo or of methylene blue ex vivo could only identify sentinel lymph nodes in a small group of patients.

A practical guide for the use of indocyanine green and methylene blue in fluorescence‐guided abdominal surgery

“…SLN mapping in colorectal cancer is still a controversial procedure, due to the relatively low visibility of the lymphatic system after injection of blue dye . In the past years NIR fluorescent imaging with other available dyes, such as ICG, was used in nine clinical studies during surgery . All studies were performed in a small population, ranges from 5 to 30 patients, who underwent laparoscopic or open surgery due to colorectal cancer.…”

“…Sentinel lymph node mapping using ICG has been evaluated for several applications in abdominal surgery (gastroenterology, urology, and gynecology) with different imaging systems . In these studies a high diversity in doses has been used, varying from 100 μg to 25 mg.…”

“…For cervical and endometrial cancer a cervical stromal injection of ICG is preferable above a hysteroscopic injection . As shown in Figure , approximately 15–30 min after injection, the sentinel lymph nodes will be visualized . In the mean‐time the surgical procedure can be started, and the surgeon will therefore lose minimal time.…”

Indocyanine Green-Enhanced Colorectal Surgery—between Being Superfluous and Being a Game-Changer

“…In our research, we analyzed 12 [ 35 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ] clinical studies regarding the role of ICG NIR in identifying the sentinel lymph node (SLN) in colon cancer surgery, in terms of procedure, detection rate, and sensitivity of the method. Overall, 337 patients were enrolled.…”

“…The outcomes were on one hand the detection rate of SLN, after ICG injection, and on the other hand the specificity, sensitivity, and negative predictive value of SLN detected by ICG fluorescence, after histopathological examination of all lymph nodes in the lymphatic basin, removed along with the tumor. In some studies, histopathological assessment was by hematoxylin–eosin examination only [ 35 , 43 , 44 , 45 , 47 , 48 , 49 ], while in others, ultrastaging of SLN by immunohistochemistry was also included [ 40 , 41 , 42 , 46 , 50 ]. A particular study design was that of Watanabe [ 45 ], who focused on detecting the aberrant lymphatic flow, which may be present in splenic flexure cancers.…”