Feasibility of sentinel lymph node detection by near-infrared endoscopy in squamous cell carcinoma of the oral cavity

Introduction Near infrared fluorescence imaging (NIR) is a new technique for intraoperative identification of sentinel lymph nodes (SLN). It has shown promising results in several surgical specialties.

Objectives: The aim of the study is to investigate the feasibility of identifying SLN by indocyanine green (ICG)-enhanced NIR endoscopy in squamous cell carcinoma of the oral cavity (OCSCC).

Methods Eight patients with (cT1-3N0) OCSCC were included. We injected 1-1.25 ml ICG (5 mg/ml) at four to five points around the tumor. After elevation of a platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were acquired with the IMAGE1 STM NIR/ICG system to define the SLN(s). We removed fluorescence-labeled SLN(s), followed by elective neck dissection.

Results The detection of at least one unilateral or bilateral SLN (range 1-5) was possible in all cases. The fluorescence signal occurred on average 4.9 ± 2.0 minutes after injection. A total of 24 SLN could be identified. Among 373 histologically examined lymph nodes we could detect one micrometastasis, which was correctly defined as SLN. False negative results were not available.

Conclusion Our first results confirm the concept of SLN regarding OCSCC using real-time NIR fluorescence endoscopy. However, this has yet to be verified by further studies.

KARL STORZ SE & Co.KG (Tuttlingen, Germany) provided the imaging system to examination without influence on the study protocol, and no financial contribution.

Conflict of interest

The first author points out the following conflict of interest: KARL STORZ SE & Co.KG (Tuttlingen, Germany) provided the imaging system to examination without influence on the study protocol, and no financial contribution.

Publication History

Article published online:
13 May 2021