Optimal settings and accuracy of indocyanine green fluorescence imaging for sentinel node biopsy in early gastric cancer

Kinami, Shinichi; Oonishi, Toshio; Fujita, Jun; Tomita, Yasuto; Funaki, Hiroshi; Fujita, Hideto; Nakano, Yukiko; Ueda, Nobuhiko; Kosaka, Takeo

doi:10.3892/ol.2016.4492

Cited by 60 publications

(75 citation statements)

References 40 publications

(71 reference statements)

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“…Of the 13 studies that were all submitted from Japan, 7 combined ICG with infrared ray electronic endoscopy (IREE), 2 combined with infrared ray laparoscopic system (IRLS), and 4 combined with fluorescence imaging (FI) system. As a novel technique, the FI method involved Infrared Camera System PDE, PDE‐2, and PDE neo …”

Section: Resultsmentioning

confidence: 99%

“…Recently developed intraoperative FI systems are able to provide simultaneous acquisition of surgical anatomy and fluorescence signal . Even SLNs that were not stained green with ICG could be clearly visualized by the bright fluorescence . Other studies reported that the FI system allowed more clear and bright visualization than NIR imaging .…”

Section: Discussionmentioning

confidence: 99%

“…The dual method is considered the most reliable method, but it requires considerably more operative time, and the patient preparation is not a simple task . Fortunately, NIR or fluorescent ICG guided SLN mapping in GC has been conducted by various institutions and has yielded acceptable pooled sensitivity of 0.94 (95%C1: 0.80‐0.99), although a wide variation exists (0.40‐1.00) . Thus, this meta‐analysis is performed to evaluate the diagnostic value of NIR or fluorescent ICG guided SLN mapping in GC, and to identify factors of this diagnostic performance.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

Jiang

Wang

et al. 2018

Journal of Surgical Oncology

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Background This meta‐analysis was conducted to evaluate the diagnostic value of near‐infrared (NIR) or fluorescent indocyanine green (ICG) guided sentinel lymph node (SLN) mapping in gastric cancer (GC). Methods This meta‐analysis was registered at the PROSPERO. Clinical studies were retrieved from the electronic database Pubmed, Embase, Medline, Web of science, and the Cochrane Library. Quality assessment was conducted by an adapted checklist of QUADAS‐2. A bivariate mixed‐effects model was used to pool the data. Evaluation of articles quality, analysis for publication bias, summary receiver operator characteristic (SROC) curves, and meta‐regression were also performed. Subgroup analysis was used to explain the heterogeneities. Results A total of 13 clinical studies (971 patients) were included. The NIR or fluorescent imaging (FI) involved infrared ray electronic endoscopy (IREE), infrared ray laparoscopic system (IRLS), and FI system. Significant evidence of heterogeneity was found for sensitivity and specificity (I 2 = 91.1% and I 2 = 98.2%), respectively. The pooled SLN sensitivity (Sen), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.94(95%CI: 0.80‐0.99), 1.00(95%CI: 0.60‐1.00), 34.0(95%CI: 9.25‐125.29), 0.06(95%CI:0.02‐0.22), and 252.50(95%CI: 94.93‐671.61), respectively. Area under curve (AUC) of SROC curve was 1.00 (95%CI: 0.99‐1.00), and the summary operating point (cut‐off value) was SENS = 0.94(95%CI: 0.80‐0.99) and SPEC = 1.00(95%CI: 0.60‐1.00). Subgroup analysis showed that NIR imaging, imaging performed 20 minutes after intraoperative injection, preoperative injection (especially for FI imaging), stained with immunohistochemistry (IHC) (+hematoxylin‐eosin [HE]), cT1 stage, submucosa injection (especially for cT1), mean number of SLN ≥ 5, study size > 26 were associated with higher SLN sensitivity. In terms of ICG concentration, diluted ICG concentration that 0.5 mg/mL (compared with 5 mg/mL) in NIR imaging and 0.05 mg/mL (compared with 0.5 mg/mL) in FI system showed higher sensitivities. However, the differences in tumor diameter (≤30 mm vs >30 mm), gastrectomy methods (opening vs laparoscopy), lymphadenectomy methods (LBD vs pick‐up), and publication year (≥2010 vs <2010) did not achieve statistical significance. Conclusion ICG combined with NIR or FI guided SLN mapping is technically feasible for GC. Based on the small sample size evidence, the IREE and IRLS devices may have higher sensitivity than FI in current clinical studies; and there may be an excessive ICG concentration used for current SLN mapping in GC. However, well‐designed further studies with large sample size are needed to confirm the best procedure and suitable criteria. Mini‐abstract This meta‐analysis was registered at PROSPERO. Clinical studies on this topic were retrieved from the electronic database Pubmed, Embase, Medline, Web of Science, and the Cochrane Library. The NIR or FI involved IREE, IRLS, and FI techniques. A total of 13 clinical studies (9...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

Jiang

Wang

et al. 2018

Journal of Surgical Oncology

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“…3). ICG fluorescence imaging enables the easy visualization of SNs and will replace the SN mapping method in many malignancies including gastric cancer [15][16][17]. Subsequently, a laparoscopic gamma probe introduced from the trocar port is used to locate the radioactive SN.…”

Section: Laparoscopic Sn Mapping Proceduresmentioning

confidence: 99%

Minimally Invasive Function-Preserving Gastrectomy with Sentinel Node Biopsy for Early Gastric Cancer

et al. 2018

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Background: Recently, minimally invasive approaches such as endoscopic treatment or laparoscopic gastrectomy for early gastric cancer have made rapid progress. However, the extent of gastrectomy and lymphadenectomy in laparoscopic surgery is radical, similar to that of open gastrectomy for patients with early gastric cancer diagnosed as not indicated for endoscopic treatment. Since it is well known that lymph node metastasis is an important prognostic factor, the standard procedure of gastrectomy with radical lymph node dissection has been performed for the purpose of curative resection. The frequency of lymph node metastases is relatively low in patients with early gastric cancer; therefore, function-preserving gastrectomy, a solution between endoscopic treatment and standard gastrectomy in terms of invasiveness, could be considered to avoid excessive invasive surgery. Summary: A prospective multicenter trial and meta-analyses of sentinel node (SN) mapping and biopsy for early gastric cancer demonstrated favorable SN detection rates and accuracy of nodal metastatic status. Personalized function-preserving gastrectomy with limited lymphadenectomy using SN theory will positively impact patients’ quality of life (QOL). Specifically, a full-thickness partial gastrectomy by laparoscopic endoscopic cooperative surgery with SN basin dissection could become a reliable technique of minimally invasive gastrectomy for treating patients with clinically node-negative (cN0) early gastric cancer. Key Messages: For early gastric cancer, the development of laparoscopic personalized minimized gastrectomy with SN navigation may improve patients’ postoperative QOL.

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“…As a result, the number of SNs in early gastric cancer is generally five to eight nodes (1,3,4). The lymphatic basins are thought to be the primary lymphatic drainage area in each patient, and patients with gastric cancer often have two or three basins (1,(3)(4)(5). The authors need to take sufficient time for detection of and decisions about the SNs and lymphatic basins, while dyeing all of the direct nodes.…”

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confidence: 99%

Perspective of new techniques overcoming laparoscopic sentinel node biopsy for early gastric cancer

Kinami

2016

Transl. Gastroenterol. Hepatol.

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The modern standard curative procedure for early gastric cancers falling outside the indication parameters for endoscopic resection is laparoscope-assisted gastrectomy with lymph node dissection. Patients undergoing standard gastrectomy with lymph node dissection experience postgastrectomy symptoms. These symptoms often pose life-long problems for patients. Thus, lymph node dissection should be avoided to preserve the stomach, alleviate the aforementioned symptoms, and improve postoperative quality of life. At present, sentinel lymph node (SN) biopsy is the most reliable method for identification of node-negative cases.A standard method of SN biopsy for early gastric cancer is combination mapping with technetium-99m-tin colloid and isosulfhan blue (1). However, blue dye deteriorates quickly, and radioactive colloids exhibit a shine through effect during gamma probe detection of hot nodes in the surgical field. We believe that combination mapping is not suitable for laparoscopic gastrectomy.Lee et al. developed a new technique for SN mapping using a fluorescent dye and visible light for early gastric cancer that was published in Annals of Surgery (2). This fluorescein method is a totally new technique and is superior because of its low cost and because it is suitable for laparoscopic surgery. I am favorably inclined towards this paper because they described the decision process of the optimal setting of the mapping to the last detail. We developed the optimal setting for ICG fluorescent mapping and also struggled through the decision process (3).Unfortunately, this paper contains a regrettable point, that is the optimal timing of the judgment about the lymphatic basins and SNs. Lee et al. stated that the number of lymphatic basins was only one in all patients, but I think this was a false conclusion. This error may be caused by a misunderstanding of the SN concept, and the setting of the timing of judgment. Sentinel nodes are defined as the first draining nodes from the primary tumor. The definition of the "first node" is the node directly receiving the lymphatics from the tumor, not the node dyeing the fastest. The lymphatic flow of the stomach is complicated, and the direction of the lymphatics from the tumor is not the sole direction; often there are two or three directions. As a result, the number of SNs in early gastric cancer is generally five to eight nodes (1,3,4). The lymphatic basins are thought to be the primary lymphatic drainage area in each patient, and patients with gastric cancer often have two or three basins (1,3-5). The authors need to take sufficient time for detection of and decisions about the SNs and lymphatic basins, while dyeing all of the direct nodes. I am one of the individuals involved in the development of blue dye mapping for gastric cancer, and the optimal timing for the decision about the SNs in blue dye mapping was about 20 minutes after intraoperative endoscopic injection (4).In recent years, one of the topics under discussion on SN mapping for gastric cancer has been ICG fluore...

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Optimal settings and accuracy of indocyanine green fluorescence imaging for sentinel node biopsy in early gastric cancer

Cited by 60 publications

References 40 publications

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

Diagnostic value of near‐infrared or fluorescent indocyanine green guided sentinel lymph node mapping in gastric cancer: A systematic review and meta‐analysis

Minimally Invasive Function-Preserving Gastrectomy with Sentinel Node Biopsy for Early Gastric Cancer

Perspective of new techniques overcoming laparoscopic sentinel node biopsy for early gastric cancer

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