Long term‑follow‑up multicenter feasibility study of ICG fluorescence‑navigated sentinel node biopsy in oral cancer

Abstract

In the current study, the utility of sentinel node (SN) identification using indocyanine green (ICG) was investigated for oral cancers in the clinical N0 stage. The current study was a prospective, multicentre, phase II clinical trial that was conducted in Japan. A total of 18 patients were included. Before surgery, the patients underwent lymphoscintigraphy to map the SNs. During surgery, radioactive isotope (RI) mapping was used to detect the SNs, and ICG was subsequently injected. ICG mapping of the SNs was then performed through the skin. The primary tumour was resected, and a neck flap was elevated for neck dissection, followed by SN biopsy (SNB) using RI or ICG mapping. With the RI method, a total of 63 SNs were detected. Among these SNs, 8 (12.7%) were positive for metastasis, including those with isolated tumour cells (ITCs). The median number of SNs per patient identified by SNB was 4. With the ICG method, a total of 67 SNs were detected. Among these SNs, 7 (10.4%) were positive for metastasis, including those with ITCs. The median number of SNs per patient identified by SNB was 4 (range, 1-6). The 5-year overall survival (OS) of all patients was 83.3%, and the 5-year disease-free survival (DFS) of all patients was 76.7%. The neck compression technique is a simple method that can be used to facilitate surgical procedures of ICG fluorescence navigated SNB for head and neck cancer.

Phosphorylcholine-conjugated gold-molecular clusters improve signal for Lymph Node NIR-II fluorescence imaging in preclinical cancer models

“…3f ). This was in accordance with clinical studies that found the timing for ICG fluorescence signal showing in the sentinel lymph nodes of certain cancers (e.g., oral cancer) was variable, causing uncertainty in the timing between injection and imaging/surgery, ranging from 15 min to up to 24 h 6 , 16 . Imaging over time in some cases observed higher tier lymph nodes in addition to the first tier dLN.…”

“…injection into 4T1 tumor. ICG 6 , 7 is known to bind to serum proteins, slowing down the kinetics of SLN draining. The signal in the lymph node increased gradually and reached peak intensity at 2-3 h post i.t.…”

A Systematic Review of Oral Biopsies, Sample Types, and Detection Techniques Applied in Relation to Oral Cancer Detection

“…SLNB uses frozen section analysis with H&E during surgery to determine the presence of metastasis in cancer. The conventional method is usually paraffin blocks followed by H&E staining [ 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ] to examine for possible metastasis and further immunohistochemical (IHC) [ 83 , 85 , 87 , 88 , 91 , 92 , 96 , 98 , 101 ] analysis for cytokeratin (AE1/AE3) [ 38 , ...…”

Sentinel Lymph Node Biopsy for Early Oral Cavity Squamous Cell Carcinoma

“…Intraoperative lymphoscintigraphy is a developing technique which has particular utility in the management of oropharyngeal or laryngeal SCC with a SLNB. These tumours are unable to be injected with a radiotracer in an awake patient for a preoperative assessment [37]. Indocyanine green (ICG) is readily taken up by lymphatics and can be identified intraoperatively using a near-infrared fluorescence camera to locate the sentinel lymph node [38].…”

“…However, it does not provide the detailed drainage information with anatomical referencing that is provided by performing radiotracer based lymphoscintigraphy with a SPECT/CT. While techniques such as skin compression have been described to identify lymphatic drainage and the SLN before making a skin incision [37], often the skin flaps need to be raised to comprehensively assess the nodal basins [39]. In addition, the ICG signal spreads rapidly with time and thus second tier lymph nodes can be hard to distinguish from the true sentinel lymph node [40].…”