Abstract：
OBJECTIVE: Evaluation of diagnostic value for lymph node (LN) metastasis and LN identification using indocyanine green (ICG) fluorescence in laparoscopic subtotal gastrectomy for gastric cancer.
METHODS: A prospective study on 79 patients who underwent radical subtotal gastrectomy with the use of ICG-guided LN dissection. The sensitivity and specificity of the ICG fluorescence lymphography method in detecting metastatic LNs were evaluated.
RESULTS: A total of 79 patients underwent surgery. The number of LNs was retrieved: 2992 LNs, of which 2392 were fluorescent (79.9%) and 600 were nonfluorescent (20.1%). The average number of LNs dissected was 37.7 ± 11.8 LNs, and the average number of fluorescent LNs was 30.3 ± 11.1; the LN metastasis rates in the total LNs and in the ICG group were 6.79% and 7.34%, respectively. The median number of retrieved LNs in patients with LN metastases (37 [IQR, 33-47]) was higher than in patients without LN metastases (36 [IQR, 27-43]), (P = .348). The median number of fluorescent LNs was significantly higher in patients with LN metastases (32 [IQR, 26-44]) than in those without LN metastases (26 [IQR, 21-36]; P < .001). The sensitivity of ICG in metastasis detection was 75.86% (22 of 29 patients), with a false-negative rate of 24.14% (7 of 29 patients). For the identification of metastatic LNs, the sensitivity of ICG was 90.7%, with the specificity of 20.8%. The negative predictive value of nonfluorescent LNs was 97%.
CONCLUSIONS: ICG fluorescence lymphography-guided lymphadenectomy can clearly visualize the lymphatic system and the LNs alongside the tumor. The high sensitivity in detecting metastatic LNs and the high negative predictive value of a nonfluorescent LNs suggest that this is an effective method for clinically radical gastrectomy for gastric cancer.
METHODS: A prospective study on 79 patients who underwent radical subtotal gastrectomy with the use of ICG-guided LN dissection. The sensitivity and specificity of the ICG fluorescence lymphography method in detecting metastatic LNs were evaluated.
RESULTS: A total of 79 patients underwent surgery. The number of LNs was retrieved: 2992 LNs, of which 2392 were fluorescent (79.9%) and 600 were nonfluorescent (20.1%). The average number of LNs dissected was 37.7 ± 11.8 LNs, and the average number of fluorescent LNs was 30.3 ± 11.1; the LN metastasis rates in the total LNs and in the ICG group were 6.79% and 7.34%, respectively. The median number of retrieved LNs in patients with LN metastases (37 [IQR, 33-47]) was higher than in patients without LN metastases (36 [IQR, 27-43]), (P = .348). The median number of fluorescent LNs was significantly higher in patients with LN metastases (32 [IQR, 26-44]) than in those without LN metastases (26 [IQR, 21-36]; P < .001). The sensitivity of ICG in metastasis detection was 75.86% (22 of 29 patients), with a false-negative rate of 24.14% (7 of 29 patients). For the identification of metastatic LNs, the sensitivity of ICG was 90.7%, with the specificity of 20.8%. The negative predictive value of nonfluorescent LNs was 97%.
CONCLUSIONS: ICG fluorescence lymphography-guided lymphadenectomy can clearly visualize the lymphatic system and the LNs alongside the tumor. The high sensitivity in detecting metastatic LNs and the high negative predictive value of a nonfluorescent LNs suggest that this is an effective method for clinically radical gastrectomy for gastric cancer.
摘要：
目的：评价吲哚菁绿(ICG)荧光对腹腔镜胃癌胃大部切除术中淋巴结转移及淋巴结鉴别的诊断价值。
方法：对79例接受根治性胃大部切除术并使用ICG引导下淋巴结清扫术的患者进行前瞻性研究。评估了ICG荧光淋巴造影方法检测转移性淋巴结的敏感性和特异性。
结果：共有79例患者接受了手术。检索到淋巴结（LN）的数量：2.992LN，其中2.392为荧光（79.9％），600为非荧光（20.1％）。平均清扫淋巴结数为37.7±11.8LN,平均荧光淋巴结数为30.3±11.1;总淋巴结和ICG组的LN转移率分别为6.79%和7.34%,分别。有LN转移[32(IQR26-44)]的患者中检索到的LN的中位数高于无LN转移[26(IQR21-36)]的患者。（p=0.348）。有LN转移的患者[32(IQR26-44)]的荧光LN的中位数明显高于无LN转移的患者[26(IQR21-36);p<0.001]。ICG检测转移灶的敏感性为75.86%(29例患者中有22例),假阴性（FN）率为24.14%（29例患者中有7例）。为了鉴定转移性LN，ICG的灵敏度为90.7%，特异性为20.8%。非荧光LN的阴性预测值为97%。
结论：ICG荧光淋巴造影引导下的淋巴结清扫术可以清楚地显示淋巴系统和肿瘤旁的淋巴结。检测转移性淋巴结的高灵敏度和非荧光淋巴结的高阴性预测值表明，这是临床上胃癌根治术的有效方法。
方法：对79例接受根治性胃大部切除术并使用ICG引导下淋巴结清扫术的患者进行前瞻性研究。评估了ICG荧光淋巴造影方法检测转移性淋巴结的敏感性和特异性。
结果：共有79例患者接受了手术。检索到淋巴结（LN）的数量：2.992LN，其中2.392为荧光（79.9％），600为非荧光（20.1％）。平均清扫淋巴结数为37.7±11.8LN,平均荧光淋巴结数为30.3±11.1;总淋巴结和ICG组的LN转移率分别为6.79%和7.34%,分别。有LN转移[32(IQR26-44)]的患者中检索到的LN的中位数高于无LN转移[26(IQR21-36)]的患者。（p=0.348）。有LN转移的患者[32(IQR26-44)]的荧光LN的中位数明显高于无LN转移的患者[26(IQR21-36);p<0.001]。ICG检测转移灶的敏感性为75.86%(29例患者中有22例),假阴性（FN）率为24.14%（29例患者中有7例）。为了鉴定转移性LN，ICG的灵敏度为90.7%，特异性为20.8%。非荧光LN的阴性预测值为97%。
结论：ICG荧光淋巴造影引导下的淋巴结清扫术可以清楚地显示淋巴系统和肿瘤旁的淋巴结。检测转移性淋巴结的高灵敏度和非荧光淋巴结的高阴性预测值表明，这是临床上胃癌根治术的有效方法。
