Related Experiment Video
Updated: Apr 14, 2026
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Published on: October 20, 2010
Near infrared fluorescence-guided lymphadenectomy during esophagectomy for esophageal squamous cell carcinoma
Sanjamjot Singh1, Vaibhav Kumar Varshney1, Ankit Rai1
1Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Background:
Lymph node metastasis is a crucial prognostic factor for esophageal squamous cell carcinoma. This study evaluated the role of near-infrared fluorescence imaging-guided lymphadenectomy during minimally invasive esophagectomy after a peritumoral indocyanine green injection.
Methods:
A prospective cohort of 30 patients with esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy with 2-field lymphadenectomy between January 2023 and December 2024 was evaluated. Preoperatively, indocyanine green dye (0.5 mL, 2.5 mg) was injected peritumoral in 4 quadrants. During lymphadenectomy, all indocyanine green-positive and -negative lymph nodes were retrieved and documented station-wise. On histopathology, the total number of lymph nodes retrieved was recorded, and indocyanine green positivity was correlated with histopathologic positivity as the primary endpoint.
Results:
The median age of the cohort was 51 years (interquartile range: 45-61 years). The commonest location of esophageal squamous cell carcinoma was lower thoracic (14 of 30, 47%), and all patients received neoadjuvant chemoradiotherapy, followed by minimally invasive esophagectomy. A total of 678 lymph nodes were retrieved, with a median of 23.5 lymph nodes per patient (interquartile range: 9-40). Overall, 56 of 678 lymph nodes (8.3%) were indocyanine green positive, of which 16 (28.6%) were positive for malignancy on histopathology. Among the 678 lymph nodes harvested, 20 (2.9%) were positive on histopathology, with 80% (16 of 20) being indocyanine green fluorescence positive. The indocyanine green positivity in lymph nodes had an 80% sensitivity, a 93% specificity, a 28.3% positive predictive value, and a 99.4% negative predictive value for accurately detecting histopathology-positive lymph nodes.
Conclusion:
Esophagectomy with indocyanine green fluorescence-guided lymphadenectomy can serve as a complementary mapping tool to enhance the clearance of histopathology-positive lymph nodes. Indocyanine green-negative nodes showed a high negative predictive value but do not replace standard anatomic lymphadenectomy.
