Near-infrared Fluorescent Image-guided Lymphatic Mapping In Esophageal Squamous Cell Carcinoma

In the recent past,the feasibility of near-infrared(NIR)image-guided sentinel lymph node(SLN)mapping had been tested in patients with gastrointestinal cancer.Indocyanine green(ICG)is a new type of fluorochrome that can stain tissue under the near-infrared fluorescence during surgery.Noninvasive imaging of the lymphatic vasculature for intraoperative diagnosis and assessment of function has been uniquely accomplished with NIR using ICG.The aim of this study was to investigate whether SLN mapping can be used to identify the mediastinal lymph node metastases during minimally invasive esophagectomy and explore the lymphatic drainage pattern of esophageal squamous cell carcinoma(ESCC)using NIR fluorescent imaging.A total of 21 patients diagnosed with c T1-T3 stage ESCC were enrolled between November 2018 and March 2019 in Shanghai Chest Hospital(Shanghai,China).Patient received a submucosal injection of indocyanine green(ICG)diluted with sodium chloride(0.9%)at the start of the esophagectomy procedure followed by NIR mapping.Thoracoscopic-assisted Mc Keown esophagectomy with NIR imaging was successfully performed for all patients.The detection rate and number of NIR+ LNs were 95.2%(20/21)and 4.0(2.0-6.5),respectively.The accuracy,false-negative rates and negative predictive value were 100%(10of 10 cases),0%(0 of 4)and 100%(6 of 6),respectively,for p T1/T2 diseases,and 80.0%(8 of 10),40%.0(2 of 5)and 71.4%(5 of 7),respectively,for p T3 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.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 p T1/2 disease.NIR imaging-guided SLN navigation appears to be a clinically beneficial less-invasive method for treating ESCC.