Mapping Lymph Node during Indocyanine Green Fluorescence-Imaging Guided Gastric Oncologic Surgery: Current Applications and Future Directions

SIMPLE SUMMARY: The intraoperative navigation techniques develop rapidly, we present an update on current use and research on indocyanine green enhanced fluorescence imaging (ICG-FI) guided lymphangiography in gastric oncological surgery. ICG serves as a promising tattooed agent for lymphangiography, its application was restricted by the false negative lymph nodes and loss of specificity in targeting tumor cells. Besides, we summarized the current approaches for gain in sensitivity and specificity of ICG-FI guided lymphangiography in gastric oncological surgery. The next direction for reinforced ICG-FI was quantification of ICG intensity and detection of ICG distribution pattern, combining with intraoperative biopsy method. ABSTRACT: Huge strides have been made in the navigation of gastric cancer surgery thanks to the improvement of intraoperative techniques. For now, the use of indocyanine green (ICG) enhanced fluorescence imaging has received promising results in detecting sentinel lymph nodes (SLNs) and tracing lymphatic drainages, which make it applicable for limited and precise lymphadenectomy. Nevertheless, issues of the lack of specificity and unpredictable false-negative lymph nodes were encountered in gastric oncologic surgery practice using ICG-enhanced fluorescence imaging (ICG-FI), which restrict its application. Here, we reviewed the current application of ICG-FI and assessed potential approaches to improving ICG-FI.