Sentinel node mapping with indocyanine green (ICG) and infrared ray detection in early gastric cancer: An accurate method that enables a limited lymphadenectomy

Abstract

Aim This study compares lymphatic mapping in early gastric cancer with ICG and infrared ray electronic endoscopy (IREE) to ICG alone. It examines the optimal method for intra-operative detection of metastases and shows long term follow up results. Methods 212 patients underwent the SN procedure with IREE and peritumoural ICG injection. Evaluated parameters were detection of sentinel nodes with IREE versus ICG alone, intra-operative detection rate of lymph node (LN) metastasis with node picking versus lymphatic basin dissection (LBD) and lymphatic drainage patterns. Results 34 patients had LN metastases. The SN identification rate and sensitivity for IREE versus ICG alone were 99.5 versus 85.8% and 97.0 versus 48.4% respectively. Intra-operative accuracy for detecting LN metastasis was 50% with node picking versus 92.3% with LBD. LN metastases were always in the SN basin. Lymphatic invasion and T-stage were risk factors for nodal metastases. Two patients showed recurrent disease. Both had a tumour with signet cell differentiation. One patient had a T3 tumour, the other patient had a tumour with a diameter of 85 mm. Conclusion The SN procedure with IREE can detect the SN and is better than ICG alone. LBD of the SN basin is required for accurate intra-operative diagnosis of metastases. LBD dissection based on IREE is a safe method of nodal dissection in patients with T1 or limited T2 tumours.