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RACS ASC 2024

Role of Indocyanine Green (ICG) in mapping sentinel cervical lymph node involvement in patients of oral squamous cell carcinoma using conventional ICG surgical system – data from a university hospital

Verbal Presentation

Verbal Presentation

5:04 pm

08 May 2024

Conway 5

SURGICAL ONCOLOGY FREE PAPERS SESSION

Presentation Description

Institution: King George Medical University - Uttar Pradesh, India

Introduction Lymph node (LN) positivity is an important determinant in a patient of oral SCC. Sentinel lymph node (SLN) biopsy may aid in minimizing the extent of elective neck dissection (ND). ICG dye facilitates the visualization of lymphatic vessels, and sentinel nodes, and provides high penetration during surgery. Materials and Methods It is a prospective observational study in 2021-2022. N=32 patients of oral SCC were injected with 1mL of ICG submucosally in 4 quadrant fashion (3,6,9 and 12 o’clock). After elevation of the platysmal flap and posterior retraction of the sternocleidomastoid muscle (15 minutes after injecting ICG), fluorescing LNs were detected using conventional surgical NIR (Near Infra-red) fluorescence imaging (STRYKER AIM 1588 camera system) and were sent for frozen section and histopathological examination (HPE). Results The majority were carcinoma buccal mucosa (53%), followed by the tongue (22%) and GB sulcus (12.5%). The most common method of ND was modified radical ND 78%, followed by supra omohyoid 12.5%, extended supra-omohyoid 6.25%, and radical ND 3.1%. A total of 755 LNs were harvested. 82 lymph nodes were identified as SLN using the ICG method. Level Ib was identified as SLN in 26/32 of the cases, followed by level Ia and level IIa (3/32 cases each). 22 out of 82 SLN were positive in the frozen section and HPE respectively with a sensitivity of 100%, specificity of 91.8% and NPV (negative predictive value) of 100%. Routine pathology demonstrated occult metastasis exclusively in SLN in 10 cases (31.25%). Conclusion NIR using ICG is a feasible and promising method for SLN biopsy in cN0 oral SCC using a conventional surgical ICG system.

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Authors

Authors

Prof Abhinav Arun Sonkar - , Dr Rohan Kapoor - , Dr Kushagra Gaurav - , Dr Akshay Anand - , Prof Awanish Kumar - , Dr Parijat Suryavanshi -