Sentinel lymph node detection in oral cancer by fluorescence navigation method using indocyanine green

Abstract

Sentinel node navigation surgery (SNNS) have received widespread application in the staging and treatment of many tumors including oral cancer. In general, radioactive colloid and dye, or both is used as the tracer for SNNS. While these methods are useful, there is some disadvantage such as radiation exposure and necessity of special equipment. Therefore, we conducted to examine the utility of fluorescence navigation using indocyanine green (ICG) for the detection of sentinel lymph node (SNL) in patients with oral cancer. Twelve patients with oral cancer were enrolled. The ICG was injected submucosal around the oral tumor. Fluorescence imaging immediately showed subcutaneous lymph nodes. After incising the cervical skin over the point of appearance of the fluorescence, the SLN was dissected under fluorescence guidance. In all patients, the SLN were successfully visualized and dissected. One patient was found to have lymph node metastases pathologically. In this report, we suggest that the method is feasible and safe, and allowing real-time observation for intraoperative detection of SLN without any radioisotope applications.