Gastric Cancer

, Volume 21, Issue 5, pp 776–781 | Cite as

Quantitative assessment of fluorescence intensity of ICG in sentinel nodes in early gastric cancer

  • Keishi Okubo
  • Yoshikazu Uenosono
  • Takaaki Arigami
  • Daisuke Matsushita
  • Shigehiro Yanagita
  • Takashi Kijima
  • Masahiko Amatatsu
  • Sumiya Ishigami
  • Kosei Maemura
  • Shoji Natsugoe
Original Article



The sentinel node (SN) detection by dual tracer method using indocyanine green (ICG) and a radioisotope (RI) has been recommended for early gastric cancer. However, institutions are limited due to radioactivity in the RI method. The greatest advantage of the RI method is that it objectively assesses RI uptake as a numerical value. The aim of the present study was to verify the usefulness of ICG fluorescence intensity in SN.


Seventeen patients with early gastric cancer were enrolled in this study. RI uptake by each lymph node was measured using Navigator GPS and fluorescence nodes were identified using the hyper eye medical system (HEMS). Fluorescence intensity in fluorescence nodes was evaluated using ICG intensity imaging software (Mizuho, Japan) of the HEMS.


The total number of dissected lymph nodes was 227, with an average of 13.3 per patient. The numbers of HN, FN-S, and FN-B were 64, 77, and 34. RI uptake was significantly greater by FN-S than by non-FN-S (P = 0.0016). The median fluorescence intensity value was higher in HN than in non-HN (P < 0.001). A correlation was observed between RI uptake and fluorescence intensity. Dissecting FNs with fluorescence intensity levels of 1–6 resulted in 92.1% dissection of HNs.


It is possible that the evaluation of fluorescence intensity is useful for selected SNs instead of RI tracer. If fluorescence intensity is measurable in surgery, an infrared fluorescence method using ICG may be useful and safe for the detection of SN in early gastric cancer.


Gastric cancer Sentinel node navigation surgery Indocyanine green Near-infrared fluorescence imaging Fluorescence intensity 


Compliance with ethical standards

Conflict of interest

None of the authors has any financial conflicts of interest regarding the study.

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. The Ethics Committee of Kagoshima University and all patients provided written informed consent to the use of their information.

Supplementary material

10120_2018_816_MOESM1_ESM.docx (31 kb)
Supplementary material 1 (DOCX 30 kb)
10120_2018_816_MOESM2_ESM.pptx (56 kb)
Supplementary Fig. 1 Correlation between RI uptake and fluorescence intensity in each lymph node. Supplementary Fig. 2 ROC curve and the AUC of fluorescence intensity in HN. (PPTX 55 kb)


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Keishi Okubo
    • 1
  • Yoshikazu Uenosono
    • 1
    • 2
  • Takaaki Arigami
    • 1
    • 2
  • Daisuke Matsushita
    • 1
  • Shigehiro Yanagita
    • 1
  • Takashi Kijima
    • 1
  • Masahiko Amatatsu
    • 1
  • Sumiya Ishigami
    • 1
  • Kosei Maemura
    • 1
  • Shoji Natsugoe
    • 1
    • 2
  1. 1.Department of Digestive Surgery, Breast and Thyroid SurgeryKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
  2. 2.Molecular Frontier Surgery, Course of Advanced TherapeuticsKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan

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