Near-Infrared Fluorescent Image-Guided Lymphatic Mapping in Esophageal Squamous Cell Carcinoma

  • PDF / 632,562 Bytes
  • 9 Pages / 595.276 x 790.866 pts Page_size
  • 58 Downloads / 161 Views

DOWNLOAD

REPORT


ORIGINAL ARTICLE – THORACIC ONCOLOGY

Near-Infrared Fluorescent Image-Guided Lymphatic Mapping in Esophageal Squamous Cell Carcinoma Haoyao Jiang, MD1, Haohua Teng, MD2, Yifeng Sun, MD, PhD1, Xufeng Guo, MD, PhD1, Rong Hua, MD, PhD1, Yuchen Su, MD1, Bin Li, MD, PhD1, Bo Ye, MD, PhD1, Yu Yang, MD1, and Zhigang Li, MD, PhD1 1

Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China; 2Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China

ABSTRACT Background. Recently, the feasibility of near-infrared (NIR) image-guided sentinel lymph node (SLN) mapping has been tested in patients with gastrointestinal cancer. The aim of this study is to investigate whether SLN mapping can be used to identify mediastinal lymph node metastases during minimally invasive esophagectomy and explore the lymphatic drainage pattern of esophageal squamous cell carcinoma (ESCC) using NIR fluorescent imaging. Patients and Methods. A total of 21 patients diagnosed with cT1–3 stage ESCC were enrolled. Patients received submucosal injection of indocyanine green diluted with sodium chloride (0.9%) at the start of the esophagectomy procedure followed by NIR mapping. Results. Thoracoscopic-assisted McKeown esophagectomy with NIR imaging was successfully performed in all patients. The detection rate and number of NIR? lymph nodes were 95.2% (20/21) and 4.0 (2.0–6.5), respectively. The accuracy, false-negative rates, and negative predictive value were 100% (10 of 10 cases), 0% (0 of 4), and 100% (6 of 6), respectively, for pT1/T2 diseases; and 80.0% (8 of

Haoyao Jiang and Haohua Teng are co-first authors.

Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-019-07969-6) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2019 First Received: 26 June 2019 Z. Li, MD, PhD e-mail: [email protected]

10), 40% (2 of 5), and 71.4% (5 of 7), respectively, for pT3 diseases. The NIR? region was the most commonly detected in the right recurrent laryngeal nerve (80%), and the NIR? region was identified in the upper mediastinal zone in 20 patients. Conclusions. Evaluation of the lymphatic drainage pattern and the application of sentinel lymph node in ESCC with real-time NIR imaging could be effective, especially in pT1/2 disease. NIR imaging-guided SLN navigation appears to be a clinically beneficial less-invasive method for treating ESCC.

Esophageal cancer is the seventh leading cause of cancer-related deaths globally with a 5-year overall survival rate of 19%.1 Esophageal squamous cell carcinoma (ESCC) is the major histological type, accounting for 88% of all cases of esophageal cancer worldwide.2 Although radiotherapy and chemotherapy have been successful in treating ESCC patients, esophagectomy is the mainstay treatment for potentially resectable esophageal cancer.3,4 As a prognostic factor, lymph node metastasis may occur in all stages o