Journal Mobile Options
Table of Contents
Vol. 25, No. 2, 2008
Issue release date: May 2008
Dig Surg 2008;25:103–108

Sentinel Node Mapping Guided by Indocyanine Green Fluorescence Imaging: A New Method for Sentinel Node Navigation Surgery in Gastrointestinal Cancer

Kusano M. · Tajima Y. · Yamazaki K. · Kato M. · Watanabe M. · Miwa M.
aDivision of General and Gastroenterological Surgery, Department of Surgery, Showa University, School of Medicine, Tokyo, and bCentral Laboratory, Hamamatsu Photonicus, Shizuoka, Japan

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Recently, gastrointestinal cancer has also been identified as a target for sentinel node navigation surgery (SNNS). This study is the first to determine the feasibility of sentinel node (SN) mapping guided by indocyanine green (ICG) fluorescence imaging in gastrointestinal cancer. Methods: Our series consisted of 22 patients with gastric cancer and 26 patients with colorectal cancer who had undergone standard surgical resection. ICG solution was injected intraoperatively into the subserosa around the tumor. Fluorescence imaging was obtained by a charge-coupled device (CCD) camera with a light-emitting diode with a wavelength of 760 nm as the light source and a cut filter to filter out light with wavelengths below 820 nm as the detector. Results: Immediately after the ICG injection, lymphatic vessels draining the tumor and round-shaped SNs were visualized by their bright fluorescence. Even SNs that were not green in color could be easily and clearly visualized by ICG fluorescence imaging. The SN detection rate and mean number of SNs were 90.9% and 3.6 ± 4.5 (mean ± SD), respectively, in patients with gastric cancer, and 88.5% and 2.6 ± 2.4, respectively, in patients with colorectal cancer. Among the patients with gastric cancer, the accuracy and false-negative rates were 88.9 and 33.3%, respectively, in patients with T1 stage cancer, and 70.0 and 60.0%, respectively, overall, in all the patients. Among the patients with colorectal cancer, the corresponding values were 100 and 0%, respectively, in patients with T1 stage cancer, and 82.6 and 66.7%, respectively, overall, in all the patients. Conclusions: Our preliminary results show that ICG fluorescence imaging allows easy, highly sensitive and real-time imaging-guided SN mapping in patients with gastric or colorectal cancer. SN mapping guided by ICG fluorescence imaging could be a promising tool deserving further clinical exploration.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Benson RC, Kues HA: Fluorescence properties of indocyanine green as related to angiography. Phys Med Biol 1978;23:159–163.
  2. Reuthebuch O, Haussler A, Genoni M, Tavakoli R, Odavic D, Kadner A, Turina M: Novadaq SPY: intraoperative quality assessment in off-pump coronary artery bypass grafting. Chest 2004;125:418–424.
  3. Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V: Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 2003;52:132–139.
  4. Sekijima M, Tojimbara T, Sato S, Nakamura M, Kawase T, Kai K, Urashima Y, Nakajima I, Fuchinoue S, Teraoka S: An intraoperative fluorescent imaging system in organ transplantation. Transplant Proc 2004;36:2188–2190.
  5. Morton DL, Wen DR, Wong JH, Economou JS, Cagle LA, Storm FK, Foshag LJ, Cochran AJ: Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 1992;127:392–399.
  6. Veronesi U, Paganelli G, Galimberti V, Viale G, Zurrida S, Bedoni M, Costa A, de Cicco C, Geraghty JG, Luini A, Sacchini V, Veronesi P: Sentinel-node biopsy to avoid axillary dissection in breast cancer with clinically negative lymphnodes. Lancet 1997;349:1864–1867.
  7. Reintgen D, Cruse CW, Wells K, Berman C, Fenske N, Glass F, Schroer K, Heller R, Ross M, Lyman G, Cox C, Rappaport D, Seigler F, Balch C: The orderly progression of melanoma nodal metastases. Ann Surg 1994;220:759–767.
  8. Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H, Motomura K, Ohigashi H, Kameyama M, Sasaki Y, Kabuto T, Ishiguro S, Imaoka S, Koyama H: Application of sentinel node biopsy to gastric cancer surgery. Surgery 2001;129:335–340.
  9. Kitagawa Y, Fujii H, Mukai M, Kubota T, Otani Y, Kitajima M: Radio-guided sentinel node detection for gastric cancer. Br J Surg 2002;89:604–608.
  10. Ichikura T, Morita D, Uchida T, Okura E, Majima T, Ogawa T, Mochizuki H: Sentinel node concept in gastric carcinoma. World J Surg 2002;26:318–322.
  11. Carlini M, Carboni F, Petric M, Santoro R, Guadagni F, Marandino F, Castelli M, Santoro E: Sentinel node in gastric cancer surgery. J Exp Clin Cancer Res 2002;21:469–473.
  12. Miwa K, Kinami S, Taniguchi K, Fushida S, Fujimura T, Nonomura A: Mapping sentinel nodes in patients with early-stage gastric carcinoma. Br J Surg 2003;90:178–182.
  13. Ajisaka H, Miwa K: Micrometastases in sentinel nodes of gastric cancer. Br J Cancer 2003;89:676–680.
  14. Nimura H, Narimiya N, Mitsumori N, Yamazaki Y, Yanaga K, Urashima M: Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg 2004;91:575–579.
  15. Arigami T, Natsugoe S, Uenosono Y, Mataki Y, Ehi K, Higashi H, Arima H, Yanagida S, Ishigami S, Hokita S, Aikou T: Evaluation of sentinel node concept in gastric cancer based on lymph node micrometastasis determined by reverse transcription-polymerase chain reaction. Ann Surg 2006;243:341–347.
  16. Ichikura T, Chochi K, Sugasawa H, Yaguchi Y, Sakamoto N, Takahata R, Kosuda S, Mochizuki H: Individualized surgery for early gastric cancer guided by sentinel node biopsy. Surgery 2006;139:501–517.
  17. Joosten JJ, Strobbe LJ, Wauters CA, Pruszczynski M, Wobbes-Truers TJ: Intraoperative lymphatic mapping and the sentinel node concept in colorectal carcinoma. Br J Surg 1999;86:482–486.
  18. Wiese DA, Saha S, Badin J, Ng PS, Gauthier J, Ahsan A, Yu L: Pathologic evaluation of sentinel lymph nodes in colorectal carcinoma. Arch Pathol Lab Med 2000;124:1759–1763.
  19. Merrie AE, vanRij AM, Phillips LV, Rossaak JI, Yun K, McCall JL: Diagnostic use of the sentinel node in colon cancer. Dis Colon Rectum 2001;44:410–417.
  20. Wong JH, Steineman S, Calderia C, Bowles J, Namiki T: Ex vivo sentinel node mapping in carcinoma of the colon and rectum. Ann Surg 2001;233:515–521.
  21. Bertagnolli M, Miedema B, Redston M, Dowell J, Niedzwiecki D, Fleshman J, Bem J, Mayer R, Zinner M, Compton C: Sentinel node staging of resectable colon cancer: results of a multicenter study. Ann Surg 2004;240:624–628.
  22. Saha S, Seghal R, Patel M, Doan K, Dan A, Bilchik A, Beutler T, Wiese D, Bassily N, Yee C: A multicenter trial of sentinel lymph node mapping in colorectal cancer: prognostic implications for nodal staging and recurrence. Am J Surg 2006;191:305–310.
  23. Tanaka E, Choi HS, Fujii H, Bawendi MG, Frangioni JV: Image-guided oncologic surgery using invisible light: completed pre-clinical development for sentinel lymph node mapping. Ann Surg Oncol 2006;13:1671–1681.
  24. Kitai T, Inomoto T, Miwa M, Shikayama T: Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer 2005;12:211–215.
  25. Kitagawa Y, Fujii H, Kumai K, Kubota T, Otani Y, Saikawa Y, Yoshida M, Kubo A, Kitajima M: Recent advances in sentinel node navigation for gastric cancer: a paradigm shift of surgical management. J Surg Oncol 2005;90:147–151.
  26. Aikou T, Kitagawa Y, Kitajima M, Uenosono Y, Bilchik AJ, Martinez SR, Saha S: Sentinel lymph node mapping with GI cancer. Cancer Metastasis Rev 2006;25:269–277.
  27. Yoneya S, Saito T, Koyama I, Takahashi K, Duvoll-Young J: Binding properties of indocyanine green in human blood. Invest Ophthalmol Vis Sci 1998;39:1286–1290.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50