Quantitative Analysis of Peri-intestinal Lymph Node Metastasis Using Indocyanine Green Fluorescence Imaging Technology

Abstract

Abstract Objective: This study evaluates the efficacy of indocyanine green fluorescence imaging (ICG-FI) compared to traditional nanocarbon dye in assessing peri-intestinal lymph node metastasis in colorectal cancer, a key factor in prognosis. The relationship between ICG-FI and histopathological outcomes in colon cancer patients is also explored. Methods: A retrospective analysis was conducted on 30 colon cancer patients (May to October 2023), confirmed by surgical pathology. Tumors were marked with ICG or nanocarbon under colonoscopy 16-24 hours pre-surgery. Post-surgery, within 15 minutes, peri-intestinal lymph node fluorescence photography and hematoxylin and eosin staining assessed the cancer foci distribution. The study measured the correlation between cancer foci distribution, fluorescence intensity, and the area under the ROC curve (AUC). Results: Out of 243 metastatic lymph nodes from 30 patients, metastases were found in 18 nodes from 9 patients. Dividing patients into metastasis and non-metastasis groups, significant differences were noted in tumor differentiation and staging (p<0.001). Fluorescence intensity strongly correlated with metastasis presence and proportion (AUC=0.931), while nanocarbon staining showed no significant correlation (p=0.81). All p-values were two-sided, with p<0.05 indicating significance. Conclusion: Lymph nodes with malignant intestinal tumor metastasis displayed weaker ICG fluorescence compared to non-metastatic nodes. Combining ICG and nanocarbon staining techniques enhances intraoperative lymph node dissection and postoperative analysis, indicating their potential utility in colorectal cancer surgeries.