Gastric Cancer

, Volume 22, Issue 4, pp 873–880 | Cite as

Prospective feasibility study for single-tracer sentinel node mapping by ICG (indocyanine green) fluorescence and OSNA (one-step nucleic acid amplification) assay in laparoscopic gastric cancer surgery

  • Yoshiaki Shoji
  • Koshi Kumagai
  • Satoshi Kamiya
  • Satoshi Ida
  • Souya Nunobe
  • Manabu Ohashi
  • Shoichi Yoshimizu
  • Yusuke Horiuchi
  • Toshiyuki Yoshio
  • Akiyoshi Ishiyama
  • Toshiaki Hirasawa
  • Tomo Osako
  • Noriko Yamamoto
  • Junko Fujisaki
  • Takeshi Sano
  • Naoki HikiEmail author
Original Article



The double-tracer method has been established for sentinel node (SN) mapping in gastric cancer surgery. However, there remain several unresolved issues that prevent its widespread use in clinical practice. In this study, we aimed to demonstrate the feasibility of single-tracer SN mapping in laparoscopic surgery for gastric cancer, using indocyanine green (ICG) fluorescence imaging with a one-step nucleic acid amplification (OSNA) assay intraoperatively.


Patients with clinical T1N0M0 gastric adenocarcinoma preoperatively were considered for inclusion if they had a single primary lesion 4 cm or less in maximal diameter. Immunohistochemical staining with the anti-cytokeratin 19 antibody was performed on preoperative biopsy specimens, and patients with faint positive reactions were excluded. Intraoperatively, single-tracer SN biopsy with ICG fluorescence imaging was performed, followed by laparoscopic gastrectomy with modified D1+ or D2 lymph node dissection.


Twenty eligible patients underwent SN biopsy and laparoscopic gastrectomy. SNs were identified in 17 cases (85%), with a median number of three SNs per patient. The median times for SN mapping and OSNA assay were 19 and 35 min, respectively. OSNA assay detected one metastatic lymph node, but all other nodes were negative. No adverse effects were observed in relation to SN mapping.


Single-tracer SN mapping by ICG fluorescence imaging with intraoperative diagnosis by OSNA assay is feasible and safe. SNs can be identified in most patients, without producing false-negative results. Further clinical trial to demonstrate the sensitivity is ongoing.


Gastric cancer Sentinel lymph node Indocyanine green Fluorescence imaging Surgical pathology 



The authors would like to thank Yuka Toyama, Hiroko Nagano, Naoko Takahashi, and Erina Okada (Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research) for providing technical assistance with the OSNA assay.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study, or the equivalent, was obtained from all patients.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  • Yoshiaki Shoji
    • 1
  • Koshi Kumagai
    • 1
  • Satoshi Kamiya
    • 1
  • Satoshi Ida
    • 1
  • Souya Nunobe
    • 1
  • Manabu Ohashi
    • 1
  • Shoichi Yoshimizu
    • 2
  • Yusuke Horiuchi
    • 2
  • Toshiyuki Yoshio
    • 2
  • Akiyoshi Ishiyama
    • 2
  • Toshiaki Hirasawa
    • 2
  • Tomo Osako
    • 3
  • Noriko Yamamoto
    • 3
  • Junko Fujisaki
    • 2
  • Takeshi Sano
    • 1
  • Naoki Hiki
    • 1
    Email author
  1. 1.Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
  2. 2.Department of Gastroenterology, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
  3. 3.Department of Pathology, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan

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