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Session: Quick Shot: Colorectal Cancer and Quality and Cost

QS203 - Effect of Fluorescence Lymph Node Mapping on Improving Diagnostic Values of CT D3 Lymph Node Staging forRight-Sided Colon Cancer

Monday, May 12, 2025
8:21 AM - 8:24 AM PT
Location: Room 9, Upper Level

    Senior Author(s)

  • DL

    Donghyoun Lee, 16 (he/him/his)

    Associate Professor
    Department of Surgery, Jeju National University Hostpital, Jeju National University College of Medicine
    jeju, Cheju-do, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Quick Shot Presenter(s)

  • Gyung Mo Son, PhD

    professor
    Pusan National Universtiy Hospital
    Busan, Pusan-jikhalsi, Republic of Korea

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • GH

    Gi Won Ha, 18

    professor
    Chonbuk National University Hospital
    Jeon Ju, Cholla-bukto, Republic of Korea

    Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.
Donghyoun Lee, 16: This individual has no financial relationships with ineligible companies.
Gyung Mo Son, PhD: This individual has no financial relationships with ineligible companies.
Purpose/Background: This study evaluated the impact of fluorescence lymph node mapping (FLNM) using indocyanine green (ICG) on the diagnostic accuracy of preoperative computed tomography (CT) in right-sided colon cancer.

Methods/Interventions: A total of 218 patients who underwent laparoscopic right hemicolectomy with D3 lymph node dissection (LND) were analyzed: 86 patients in the FLNM group and 132 in the conventional surgery group. The FLNM technique allowed for enhanced intraoperative visualization of lymph node (LN) and more precise dissection, improving the identification of metastatic LNs. The diagnostic value of preoperative CT staging was assessed in both the FLNM and control groups by calculating the apparent prevalence, true prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value, positive likelihood ratio (PLR), negative likelihood ratio, false positive and false negative proportions, and accuracy.

Results/Outcomes: FLNM increased the accuracy of CT staging for detecting D3 LN metastasis in advanced cancer cases, with a higher PPV, PLR, and accuracy. In the FLNM group, the false-positive rate was significantly reduced, and the specificity was higher compared to the control group. Multivariate analysis identified FLNM as an independent factor associated with improved D3 LN metastasis detection. These findings suggest that incorporating FLNM into surgical procedures enhances the diagnostic value of preoperative CT by improving the precision of LND, particularly in patients with advanced colon cancer.

Conclusion/Discussion: The use of FLNM for D3 LND enhances the diagnostic accuracy of cN staging in right-sided colon cancer by improving surgical precision.

Patient flowchart illustrating the enrollment and allocation of participants in the study.

Images of D3 lymph node (LN) with and without metastasis
(A) CT image of a D3 LN. (B) D3 LN under white light during surgery. (C) ICG fluorescence image of the D3 LN obtained with a laparoscopic near-infrared camera. (D) Pathologic image of the D3 LN (H&E staining). (1) Patient with no D3 LN metastasis on both CT and pathologic images. (2) Patient with no metastasis on CT but with metastasis on the pathologic image. (3) Patient with suspicious D3 LN metastasis on CT but no metastasis on the pathologic image. (4) Patient with D3 LN metastasis on both CT and pathologic images. The red arrow indicates the LNs observed in the D3 region on CT imaging. White arrows indicate areas within the LNs containing cancer cells. Cases (2) and (3) illustrate discrepancies between CT and pathologic images in detecting D3 LN metastasis.