Near-infrared fluorescence imaging for sentinel lymph node identification in colon cancer: a prospective single-center study and systematic review with meta-analysis

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Abstract

Background

Near-infrared (NIR) fluorescence imaging has the potential to overcome the current drawbacks of sentinel lymph node mapping (SLNM) in colon cancer. Our aim was to provide an overview of current SLNM performance and of factors influencing successful sentinel lymph node (SLN) identification using NIR fluorescence imaging in colon cancer.

Methods

A systematic review and meta-analysis was conducted to identify currently used methods and results. Additionally, we performed a single-center study using indocyanine green (ICG) as SLNM dye in colon cancer patients scheduled for a laparoscopic colectomy. SLNs were analyzed with conventional hematoxylin-and-eosin staining and additionally with serial sectioning and immunohistochemistry (extended histopathological assessment). A true-positive procedure was defined as a tumor-positive SLN either by conventional hematoxylin-and-eosin staining or by extended histopathological assessment, independently of regional lymph node status. SLN procedures were determined to be true negatives if SLNs and regional lymph nodes revealed no metastases after conventional and advanced histopathology. SLN procedures yielding tumor-negative SLNs in combination with tumor-positive regional lymph nodes were classified as false negatives. Sensitivity, negative predictive value and detection rate were calculated.

Results

This systematic review and meta-analysis included 8 studies describing 227 SLN procedures. A pooled sensitivity of 0.63 (95% CI 0.51–0.74), negative predictive value 0.81 (95% CI 0.73–0.86) and detection rate of 0.94 (95% CI 0.85–0.97) were found. Upstaging as a result of extended histopathological assessment was 0.15 (95% CI 0.07–0.25). In our single-center study, we included 30 patients. Five false-negative SLNs were identified, resulting in a sensitivity of 44% and negative predictive value of 80%, with a detection rate of 89.7%. Eight patients had lymph node metastases, in three cases detected after extended pathological assessment, resulting in an upstaging of 13% (3 of 23 patients with negative nodes by conventional hematoxylin and eosin staining).

Conclusions

Several anatomical and technical difficulties make SLNM with NIR fluorescence imaging in colon cancer particularly challenging when compared to other types of cancer. As a consequence, reports of SLNM accuracy vary widely. Future studies should try to standardize the SLNM procedure and focus on early-stage colon tumors, validation of tracer composition, injection mode and improvement of real-time optical guidance.

Electronic supplementary material

The online version of this article (10.1007/s10151-019-02107-6) contains supplementary material, which is available to authorized users.

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Mitsuo Kusano, Yusuke Tajima, Kimiyasu Yamazaki … (2008)

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Ronan Cahill, Mark Anderson, Lai-Mun Wang … (2012)

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Author and article information

Contributors

M. Ankersmit:

ORCID: http://orcid.org/0000-0002-4256-3720

+31 20 4445234 , m.ankersmit1@vumc.nl

Journal

Journal ID (nlm-ta): Tech Coloproctol

Journal ID (iso-abbrev): Tech Coloproctol

Title: Techniques in Coloproctology

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1123-6337

ISSN (Electronic): 1128-045X

Publication date (Electronic): 18 November 2019

Publication date PMC-release: 18 November 2019

Publication date (Print): 2019

Volume: 23

Issue: 12

Pages: 1113-1126

Affiliations

[1 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Department of Surgery, Cancer Center Amsterdam, , Amsterdam UMC-Vrije Universiteit Amsterdam, ; De Boelelaan 1117, Amsterdam, The Netherlands

[2 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Department of Operating Rooms and MITeC Technology Center, , Radboud University Medical Center, ; Nijmegen, The Netherlands

[3 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Medical Library, , Amsterdam UMC, Vrije Universiteit Amsterdam, ; Amsterdam, The Netherlands

[4 ]GRID grid.414725.1, ISNI 0000 0004 0368 8146, Department of Surgery, , Meander Medisch Centrum, ; Amersfoort, The Netherlands

Author information

M. Ankersmit http://orcid.org/0000-0002-4256-3720

Article

Publisher ID: 2107

DOI: 10.1007/s10151-019-02107-6

PMC ID: 6890578

PubMed ID: 31741099

SO-VID: 478fe166-28fd-4d5f-b26b-8fc09ebd3d55

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.