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Performance of Indocyanine-Green Imaging for Sentinel Lymph Node Mapping and Lymph Node Metastasis in Esophageal Cancer: Systematic Review and Meta-Analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background and Objectives

Lymphatic mapping with indocyanine-green (ICG) and near-infrared light fluorescent imaging is widely used for sentinel lymph node staging in different types of cancer but is not fully accepted for all procedures because studies have reported heterogeneous results. This study aimed to assess the detection rate (DR) of ICG imaging for sentinel lymph node mapping (SLNM) and lymph node metastases (LNMs) in esophageal cancer.

Methods

A systematic search was performed to identify relevant studies examining the use of ICG imaging for SLNM in patients with esophageal cancer. Extracted results were pooled in a single-proportion meta-analysis, with a random-effects model, presented as forest plots.

Results

Six studies were included in the analysis. The ICG DR for SLNM was 89% [95% confidence interval (CI) 71%–96%]. The pooled sensitivity and specificity values for the detection of LNMs were 84% (95% CI 64%–94%) and 15% (95% CI 3%–45%), respectively. A trend towards a lower DR was found with increasing mean latency time between ICG injection and SLNM.

Conclusions

ICG imaging is a technique that potentially could improve lymph node yield excision and, as a consequence, improve the detection of lymph node metastases.

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Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

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Acknowledgement

We would like to acknowledge AIS-Channel and International Surgery for their help in the reading and correction of this manuscript.

Funding

There was no funding for this manuscript.

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Author notes

  1. Julio Jimenez-Lillo and Eduardo Villegas-Tovar have contributed equal to this work.

Authors and Affiliations

  1. Evidence-Based Health Care Department, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain

    Julio Jimenez-Lillo MD, Eduardo Villegas-Tovar MD, Dulce Momblan-Garcia MD, Victor Turrado-Rodriguez MD, Ainitze Ibarzabal-Olano MD, Borja De Lacy MD, Alejandro Diaz-Giron-Gidi MD, Raigam J. Martinez-Portilla MD & Antonio Lacy PhD

  2. Medica Sur Hospital, Mexico City, Mexico

    Eduardo Villegas-Tovar MD & Regina Faes-Petersen MD

  3. High Specialty Regional Hospital of the Yucatan Peninsula, Merida, Yucatan, Mexico

    Regina Faes-Petersen MD

  4. Clinical Research Department, National Institute of Perinatology, Mexico City, Mexico

    Raigam J. Martinez-Portilla MD

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  1. Julio Jimenez-Lillo MD
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Corresponding author

Correspondence to Raigam J. Martinez-Portilla MD.

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Ethics approval statement

Our hospital does not require ethics approval for systematic reviews and meta-analyses.

Disclosures

Julio Jimenez-Lillo has no conflicts of interest or financial ties to disclose. Eduardo Villegas-Tovar has no conflicts of interest or financial ties to disclose. Dulce Momblan-Garcia has no conflicts of interest or financial ties to disclose. Victor Turrado-Rodriguez has no conflicts of interest or financial ties to disclose. Ainitze Ibarzabal-Olano has no conflicts of interest or financial ties to disclose. Borja De Lacy has no conflicts of interest or financial ties to disclose. Alejandro Diaz-Giron Gidi has no conflicts of interest or financial ties to disclose. Regina Faes-Petersen has no conflicts of interest or financial ties to disclose. Dr. Raigam J Martinez-Portilla has no conflicts of interests but states that he has relevant financial activities outside the submitted work, receiving personal fees from General Electric and Siegfried Rhein pharmaceutical. There are no other relationships, conditions or circumstances that present a potential conflict of interest to disclose. Dr. Antonio Lacy has no conflicts of interest but states that he has relevant financial activities, outside of the submitted work, receiving grants from Medtronic and Olympus, and personal fees from Applied Medical and Conmed. There are no other relationships, conditions or circumstances that present a potential conflict of interest to disclose.

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Jimenez-Lillo, J., Villegas-Tovar, E., Momblan-Garcia, D. et al. Performance of Indocyanine-Green Imaging for Sentinel Lymph Node Mapping and Lymph Node Metastasis in Esophageal Cancer: Systematic Review and Meta-Analysis. Ann Surg Oncol 28, 4869–4877 (2021). https://doi.org/10.1245/s10434-021-09617-4

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