吲哚菁绿荧光导航的侧方前哨淋巴结活检在腹腔镜直肠癌侧方淋巴结清扫中的临床意义

The clinical significance of lateral pelvic sentinel lymph node biopsy using indocyanine green fluorescence navigation in laparoscopic lateral pelvic lymph node dissection

目的探讨应用吲哚菁绿(ICG)荧光导航技术的直肠癌侧方前哨淋巴结活检(SLNB)在腹腔镜直肠癌侧方淋巴结清扫(LLND)中的临床意义,评估该技术预测侧方淋巴结(LPLN)状态的准确性和可行性。方法回顾性分析2017年4月至2022年10月中国医学科学院肿瘤医院结直肠外科在腹腔镜直肠癌LLND术中行ICG荧光导航的侧方SLNB的16例直肠癌患者的临床病理资料。入组患者未行术前新辅助放疗且LPLN可见但未明确转移(在高分辨率MRI图像中,LPLN最大短径为5.0~9.9 mm)。随访观察患者的术后并发症。结果16例患者均在腹腔镜直肠癌LLND术中成功完成ICG荧光导航的侧方SLNB。3例患者行双侧LLND,13例患者行单侧LLND。14例患者侧方前哨淋巴结(SLN)可见明显荧光显像,SLN检出率为87.5%。其中2例患者侧方SLN术中冰冻病理发现肿瘤转移,12例患者侧方SLN术中冰冻病理阴性。在14例侧方SLN荧光显像的患者中,侧方清扫的非前哨淋巴结(NSLB)均为阴性。2例无侧方SLN荧光显像的患者,所有切除的LPLN均为阴性。SLNB的特异度为85.7%,灵敏度、阴性预测值和准确性均为100%。术后1例患者出现切口感染,1例患者出现造口周围皮炎。结论ICG荧光导航的侧方SLNB在预测LPLN状态方面安全可行,并具有良好的准确性,该技术有望替代局部晚期直肠癌的预防性LLND。

Objectives This study aims to explore the clinical significance of lateral pelvic sentinel lymph node biopsy(SLNB)using indocyanine green(ICG)fluorescence navigation in laparoscopic lateral pelvic lymph node dissection(LLND)and evaluate the accuracy and feasibility of this technique to predict the status of lateral pelvic lymph nodes(LPLNs).Methods The clinical and pathological characteristics,surgical outcomes,lymph node findings and perioperative complications of 16 rectal cancer patients who underwent SLNB using ICG fluorescence navigation in laparoscopic LLND in the Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College during April 2017 and October 2022 were retrospectively collected and analyzed.The patients did not receive preoperative neoadjuvant radiotherapy and presented with LPLNs but without LPLN enlargement(MRI showed the maximum short axes of the LPLNs were≥5 mm and<10 mm at first visit).Results All 16 patients were successfully performed SLNB using ICG fluorescence navigation in laparoscopic LLND.Three patients underwent bilateral LLND and 13 patients underwent unilateral LLND.The lateral pelvic sentinel lymph nodes(SLNs)were clearly fluorescent before dissection in 14 patients and the detection rate of SLNs for these patients was 87.5%.Lateral pelvic SLN metastasis was diagnosed in 2 patients and negative results were found in 12 patients by frozen pathological examinations.Among the 14 patients in whom lateral pelvic SLNs were detected,the dissected lateral pelvic non-SLNs were all negative.All dissected LPLNs were negative in two patients without fluorescent lateral pelvic SLNs.The specificity,sensitivity,negative predictive value,and accuracy was 85.7%,100%,100%,and 100%,respectively.Conclusions This study indicates that lateral pelvic SLNB using ICG fluorescence navigation shows promise as a safe and feasible procedure with good accuracy.This technique may replace preventive LLND for locally advanced lower rectal cancer.