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10.1245/s10434-008-9872-7
Annals of Surgical Oncology 15:1640-1643 (2008)
© 2008 Society of Surgical Oncology
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Original Article

Detection of Sentinel Node in Gastric Cancer Surgery by Indocyanine Green Fluorescence Imaging: Comparison with Infrared Imaging

Isao Miyashiro, MD1, Norikatsu Miyoshi, MD1, Masahiro Hiratsuka, MD2, Kentaro Kishi, MD1, Terumasa Yamada, MD1, Masayuki Ohue, MD1, Hiroaki Ohigashi, MD1, Masahiko Yano, MD1, Osamu Ishikawa, MD1 and Shingi Imaoka, MD1

1 Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan
2 Department of Surgery, Itami Municipal Hospital, 1-100 Koyaike, Itami, Hyogo 664-0015, Japan

Correspondence: Address correspondence and reprint requests to: Isao Miyashiro, MD; E-mail: miyashir{at}biken.osaka-u.ac.jp

Background: Secure methods for clinical detection of the sentinel node (SN) are in great demand to avoid unnecessary resection. This was a clinical exploration/feasibility study of a novel detection system for SN biopsy using indocyanine green (ICG) fluorescence imaging in gastric cancer surgery.

Methods: SN biopsy using ICG dye was performed in three patients who had gastric cancer. ICG fluorescence images were obtained using a detection system comprising a charge-coupled device (CCD) camera with a cut filter as the detector and light emitting diodes (LED) as the light source. The nodes were also examined simultaneously by an infrared (IR) imaging videoscope.

Results: Immediately after intraoperative ICG injection, the fluorescence imaging system allowed easy visualization of the lymphatic vessels draining from the primary gastric tumor toward the lymph nodes and tracing of the moving injected dye. Some lymph vessels and nodes were hardly recognized by ICG green color or IR imaging. The ICG fluorescence system also allowed visualization of the lymph node when ICG was injected the day before surgery, similar to the radio-guided method.

Conclusions: Detection of SNs in gastric cancer surgery using the ICG fluorescence imaging system is a promising novel technique and may perhaps prove useful for laparoscopic surgery.

Key Words: Sentinel node • Gastric cancer • Indocyanine green fluorescence imaging • Light emitting diode (LED) • Infrared (IR) imaging






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