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Updated: Jun 11, 2026
Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Published on: October 20, 2010
Fluorescence-guided lymph node identification for biopsy for suspected lymphoproliferative disease or excision of
Salvador Morales-Conde1,2, Maria Vannucci3,4, Beatriz Gómez-García1
1Department of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Sevilla, Spain.
Insights
Indocyanine green (ICG) fluorescence is a feasible tool for identifying abdominal lymph nodes during surgery when biopsies are difficult. Administering ICG at anesthesia induction simplifies the process with similar visualization success rates.
Area of Science:
- Surgical Oncology
- Medical Imaging
- Diagnostic Technology
Background:
- Fine needle aspiration cytology (FNAC) is not always feasible for abdominal lymph node biopsy.
- Intraoperative localization of lymph nodes in challenging anatomical regions requires advanced techniques.
Purpose of the Study:
- To assess the feasibility of indocyanine green (ICG) fluorescence for intraoperative abdominal lymph node localization.
- To compare ICG administration at 24 hours versus anesthesia induction for visualization effectiveness.
Main Methods:
- Retrospective feasibility study including patients with lesions unsuitable for ultrasound-guided biopsy.
- Patients received intravenous ICG 24 hours before surgery (Group A) or at anesthesia induction (Group B).
- Fluorescence findings were compared with preoperative PET-CT and histology.
Main Results:
- ICG fluorescence visualized 76.5% of lesions across both groups (13/17).
- Visualization rates were similar between Group A (75%) and Group B (77.8%).
- Successful visualization included retroperitoneal, mesenteric, and supraclavicular lymph nodes.
Conclusions:
- ICG fluorescence is a feasible and safe intraoperative adjunct for lymph node identification in difficult surgical areas.
- Administering ICG at anesthesia induction streamlines workflow without compromising visualization.
- Findings are exploratory, warranting further investigation due to sample size and selection bias.
Purpose:
To evaluate the feasibility of indocyanine green (ICG) fluorescence as an intraoperative tool for abdominal lymph-node localization in cases where fine needle aspiration cytology (FNAC), is not feasible. ICG was administered either 24 hours before surgery or at anaesthesia induction, and fluorescence findings were descriptively compared with preoperative imaging and histology.
Materials And Methods:
This is a retrospective exploratory feasibility study. Patients undergoing excision of primary or metastatic lesions in areas not suitable for ultrasound-guided biopsy were included. Suspicious findings on computed tomography (CT) scan were confirmed with positron emission tomography (PET)-CT preoperatively. According to intravenous ICG administration, patients were divided into two groups: group A, 24-hours before surgery, and group B, at anaesthesia induction. Fluorescence visualization was descriptively assessed in relation to PET-CT findings and histology.
Results:
Eight patients were included in group A and nine in group B. ICG fluorescence enabled intraoperative visualization of 13 out of 17 lesions overall (76.5%), including six out of eight in group A (75%), and seven out of nine in group B (77.8%), including retroperitoneal, mesenteric, and supraclavicular locations. Because PET-CT positivity was part of the inclusion pathway, descriptive concordance indicators are reported for descriptive purposes only. Visualization rates were comparable between the two protocols.
Conclusions:
Fluorescence appears to be a feasible and safe intraoperative adjunct for lymph-node identification in anatomically challenging regions. Administration at anaesthesia induction simplifies perioperative workflow while maintaining similar visualization rates. These findings are exploratory and hypothesis-generating and should be interpreted considering the small sample size and the selection bias related to PET-positive inclusion criteria.
