Use of fluorescence imaging and indocyanine green for sentinel node mapping during gastric cancer surgery: Results of an intercontinental Delphi survey

Danny A. Sherwinter, Luigi Boni, Michael Bouvet, Lorenzo Ferri, Woo Jin Hyung, Takeaki Ishizawa, Ronald N. Kaleya, Kaitlyn Kelly, Norihiro Kokudo, Enrique Lanzarini, Misha D.P. Luyer, Norio Mitsumori, Carmen Mueller, Doo Joong Park, Dario Ribero, Riccardo Rosati, Jelle P. Ruurda, Meindert Sosef, Sylke Schneider-Koraith, Giuseppe SpinoglioVivian Strong, Naoto Takahashi, Hiroya Takeuchi, Bas P.L. Wijnhoven, Han Kwang Yang, Fernando Dip, Emanuele Lo Menzo, Kevin P. White, Raul J. Rosenthal*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Downloads (Pure)


BACKGROUND: Understanding the extent of tumor spread to local lymph nodes is critical to managing early-stage gastric cancer. Recently, fluorescence imaging with indocyanine green has been used to identify and characterize sentinel lymph nodes during gastric cancer surgery, but no published guidelines exist. We sought to identify areas of consensus among international experts in the use of fluorescence imaging with indocyanine green for mapping sentinel lymph nodes during gastric-cancer surgery. METHODS: In this 2-round, online Delphi survey, 27 international experts voted on 79 statements pertaining to patient preparation and contraindications to fluorescence imaging with indocyanine green during gastric cancer surgery; indications; technical aspects; advantages/disadvantages and limitations; and training and research. Methodological steps were adopted during survey design to minimize bias. RESULTS: Consensus was reached on 61 of 79 statements, including giving single injections of indocyanine green into each of the 4 quadrants peritumorally, administering indocyanine green on the same day as surgery, injecting a total of 1 to 5 mL of 5 mg/mL indocyanine green, injecting endoscopically into submucosa, and repeating indocyanine green injections a second time if sentinel lymph node visualization remains inadequate. Consensus also was reached that fluorescence imaging with indocyanine green is an acceptable single-agent modality for sentinel lymph node identification and that the sentinel lymph node basin method is preferred. However, sentinel lymph node dissection should be limited to T1 gastric cancer and tumors ≤4 cm in diameter, and further research is necessary to optimize the technique and render fluorescence-guided sentinel lymph nodes dissection acceptable for routine clinical use. CONCLUSION: Although considerable consensus was achieved, further research is necessary before this technology should be used in routine practice.

Original languageEnglish
Pages (from-to)S29-S37
Issue number6
Publication statusPublished - 1 Dec 2022

Bibliographical note

Diagnostic Green; Intuitive; Medtronic; Olympus; Karl Storz;
Stryker: Each provided unrestricted grants for the International
Society for Fluorescence Guided Surgery (ISFGS) Advisory Board
meeting, Frankfurt, Germany, September 8, 2019, during which the
Delphi consensus was discussed. Diagnostic Green also funded
accommodations and meals. Diagnostic Green, Medtronic, Karl
Storz, Stryker, Arthrex, and Richard Wolf provided additional
financial support to ISFGS for this publication.

Publisher Copyright:
Copyright © 2022. Published by Elsevier Inc.


Dive into the research topics of 'Use of fluorescence imaging and indocyanine green for sentinel node mapping during gastric cancer surgery: Results of an intercontinental Delphi survey'. Together they form a unique fingerprint.

Cite this