Mapping Lymph Node during Indocyanine Green Fluorescence-Imaging Guided Gastric Oncologic Surgery: Current Applications and Future Directions

Abstract

Huge strides have been made in the navigation of gastric cancer surgery thanks to the improvement of intraoperative techniques. For now, the use of indocyanine green (ICG) enhanced fluorescence imaging has received promising results in detecting sentinel lymph nodes (SLNs) and tracing lymphatic drainages, which make it applicable for limited and precise lymphadenectomy. Nevertheless, issues of the lack of specificity and unpredictable false-negative lymph nodes were encountered in gastric oncologic surgery practice using ICG-enhanced fluorescence imaging (ICG-FI), which restrict its application. Here, we reviewed the current application of ICG-FI and assessed potential approaches to improving ICG-FI.

Fluorescence imaging-guided surgery: current status and future directions

“…Notably, NIR FI excels in detecting relatively superficial cancers, while its capability to identify deeper-seated tumors is limited. 89,90 Further investigations confirmed the efficacy of NIR FI with ICG in HCC patients, unveiling an unexpected divergence. Unlike liver metastases, ICG accumulated within the HCC tumors rather than in the surrounding peripheral region of colorectal liver metastases.…”

“…Notably, NIR FI excels in detecting relatively superficial cancers, while its capability to identify deeper-seated tumors is limited. 89,90…”

Targeting Patient-Derived Orthotopic Gastric Cancers with a Fluorescent Humanized Anti-CEA Antibody

“…There have been numerous studies investigating the role of indocyanine green (ICG) in detecting sentinel lymph nodes, nodes containing metastatic disease, or the improved detection and thus completion of a D2 lymphadenectomy. [52][53][54][55][56][57][58][59] Despite the robust body of research on the use of ICG in gastric cancer lymphadenectomy, its use has yet to become incorporated into the current guidelines or to become the standard of care. 60 This is likely due to the complex lymphatic drainage of the stomach and nonspecific nature of ICG.…”

Use of indocyanine green near-infrared lymphography to detect sentinel lymph nodes in a dog with a malignant insulinoma: a case report

“…Sentinel node mapping using indocyanine green (ICG) and near-infrared fluorescence (NIR-F) offers a potential alternative approach for identifying and removing early metastatic lymph nodes in affected dogs. In human medicine, SLN mapping using ICG and NIR-F has been mainly used to detect the intestinal nodes in patients with colonic or gastric cancer, with varying success rates ( 17 – 19 ). To date, no reports of intestinal SLN mapping exist for dogs ( 20 ).…”