Objectives: Occult cervical lymph node metastasis is the most important reason for recurrence of early-stage tongue cancer and oropharyngeal cancer. Cervical sentinel lymph node (SLN) biopsy may help to identify them. Pigment dyes and radionuclide were used to label SLN. Both of them had shortage. This study aims to investigate the application and clinical value of indocyanine green fluorescence imaging in cervical SLN biopsy for patients with early-stage tongue cancer and oropharyngeal cancer.
Methods: Retrospective analysis was conducted on 23 patients with early tongue cancer and oropharyngeal cancer, who received surgical treatment and used indocyanine green as a tracer to find SLN in Hunan Cancer Hospital from April to October 2021. The detection rate of SLN was calculated and the distribution of SLN in different regions of the neck was analyzed.
Results: SLN was successfully identified in 22 of 23 patients, with a detection rate of 95.65%. Among these 22 patients, 3 patients were found to have cancer metastasis, and the rate of occult lymph node metastasis was 13.63%. No pathologically positive lymph nodes were detected in SLN-negative patients, and thus the positive predictive rate was 100%. For patients with primary lesions located in the anterior 2/3 of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 15.15%, 71.72%, 13.13%, and 0, respectively. For patients with primary lesions located in base of the tongue, the constituent ratios of SLN in neck area I, II, III, and IV were 0, 44.44%, 44.44%, and 11.12%, respectively.
Conclusions: Indocyanine green fluorescence imaging has a high detection rate with accurate positive prediction in the anterior cervical SLN biopsy in patients with early-stage tongue cancer and oropharyngeal cancer. Meanwhile, it can also reflect the lymphatic drainage of tumors located at different primary sites, which has high clinical value.
目的: 颈部淋巴结的隐匿性转移是导致舌癌及口咽癌复发的重要原因。颈部前哨淋巴结(sentinel lymph node，SLN)活检有助于筛选存在隐匿性转移的患者。以往多使用活性染料或放射性核素标示SLN，但均存在一定的缺点。本研究使用吲哚菁绿作为示踪剂，探讨其在早期舌癌及口咽癌颈部SLN活检中的应用及临床价值。方法: 回顾性分析2021年4至10月在湖南省肿瘤医院接受外科治疗并使用吲哚菁绿作为示踪剂寻找SLN的早期舌癌及口咽癌患者23例。计算SLN检出率和分析SLN在颈部各区的分布情况。结果: 在23例患者中，22例成功定位SLN，检出率95.65%。在22例成功定位SLN的患者中，共发现3例有癌转移，隐匿性淋巴结转移率13.63%。SLN阴性患者颈部淋巴结清扫标本中未检出病理阳性淋巴结，阳性预测率100%。舌原发病灶位于舌前2/3的患者颈部I、II、III、IV区SLN的占比分别为15.15%、71.72%、13.13%、0；舌原发病灶位于口咽舌根部位的患者颈部I、II、III、IV区SLN的占比分别为0、44.44%、44.44%、11.12%。结论: 在早期舌癌及口咽癌患者颈部SLN活检中使用吲哚菁绿荧光显影可得到较高的SLN检出率，阳性预测准确，同时还可直观反映出不同部位的原发灶的淋巴引流规律，具有较高的临床应用价值。.
Keywords: indocyanine green fluorescence imaging; oropharyngeal cancer; sentinel lymph node; tongue cancer.