Identification of Metastatic Lymph Nodes Using Indocyanine Green Fluorescence Imaging

SIMPLE SUMMARY: Indocyanine green (ICG)-based fluorescence imaging has been used to detect several types of tumors; however, its ability to detect metastatic lymph nodes (LNs) remains unclear. The feasibility of ICG for detecting tumors and metastatic LNs was evaluated in patients with lung or esophageal cancer, detected with computed tomography (CT) or positron-emission tomography (PET)/CT, and scheduled to undergo surgical resection. ICG-based fluorescence imaging could identify metastatic lymph nodes and enable surgeons to dissect them, potentially preventing cancer recurrence. However, the feasibility of ICG-based intraoperative detection of metastatic lymph nodes needs to be validated with further studies. ABSTRACT: Indocyanine green (ICG) has been used to detect several types of tumors; however, its ability to detect metastatic lymph nodes (LNs) remains unclear. Our goal was to determine the feasibility of ICG in detecting metastatic LNs. We established a mouse model and evaluated the potential of ICG. The feasibility of detecting metastatic LNs was also evaluated in patients with lung or esophageal cancer, detected with computed tomography (CT) or positron-emission tomography (PET)/CT, and scheduled to undergo surgical resection. Tumors and metastatic LNs were successfully detected in the mice. In the clinical study, the efficacy of ICG was evaluated in 15 tumors and fifty-four LNs with suspected metastasis or anatomically key regional LNs. All 15 tumors were successfully detected. Among the fifty-four LNs, eleven were pathologically confirmed to have metastasis; all eleven were detected in ICG fluorescence imaging, with five in CT and seven in PET/CT. Furthermore, thirty-four LNs with no signals were pathologically confirmed as nonmetastatic. Intravenous injection of ICG may be a useful tool to detect metastatic LNs and tumors. However, ICG is not a targeting agent, and its relatively low fluorescence makes it difficult to use to detect tumors in vivo. Therefore, further studies are needed to develop contrast agents and devices that produce increased fluorescence signals.