Novel color fluorescence imaging for sentinel lymph node detection in oral and oropharyngeal cancer

Abstract

Aim: Fluorescence imaging (FI) using indocyanine green (ICG) is a noteworthy alternative technique for sentinel lymph node (SLN) detection without radiation exposure in oral cavity and oropharynx cancer. However, conventional FI is monochrome, so the visibility is limited. This study assessed whether color FI using the HyperEye Medical System (HEMS) is feasible as an alternative for SLN detection. Methods: Patients with previously untreated cT1-2N0 oral or oropharyngeal cancer who were to undergo primary tumor resection and elective neck dissection (END) in our hospital were enrolled from November 2012 to March 2016. The patients underwent SLN detection for biopsy via the HEMS following the injection of ICG solution around the primary lesion before neck dissection. The visibility and the diagnostic accuracy of the imaging were evaluated.Results: SLNs were visualized in all eight cases; however, transcutaneous fluorescence detection was not observed in all cases. Utilizing color mode imaging simplified harvest by clearly discriminating SLNs from surrounding structures, while the monochrome mode proved to be more sensitive for detection. Two cases showed occult metastases on both sentinel and regional nodes. The identification and false negative rates were 100% and 0%, respectively. There were no complications incurred due to this method. Conclusion:Our results suggest that color FI with the HEMS allows for the accurate and safe harvest of SLNs with a preparatory skin incision. Although there is room for improvement of sensitivity, this easy-to-handle procedure might provide the potential to expand the role of the ICG method for SLN detection in head and neck cancer.

Progress in the Application of Fluorescent Probes in Oral Tumor Diseases

“…Miyamoto and colleagues [18] conducted a study where they injected indocyanine green (ICG) around the primary sites of oropharyngeal cancer in patients who had not yet received treatment. This was done to evaluate ICG as an alternative technique for identifying sentinel lymph nodes (SLNs).…”

Human Papillomavirus-Related Non-Metastatic Oropharyngeal Carcinoma: Current Local Treatment Options and Future Perspectives

“…A recently published study analyzed the role of fluorescence imaging using indocyanine green as a noteworthy alternative technique for sentinel lymph node (SLN) and additional occult regional metastases detection in early-stage node negative (cN0) OPSCC. Utilizing color mode imaging clearly discriminated SLNs from the surrounding structures and the rate of identification of SLNs and false negative rate were 100% and 0%, respectively [ 30 ].…”