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Poster - 274
Indocyanine Green Fluorescence Imaging in Pediatric Renal Tumors: Advancing Standardization for Sentinel Lymph Node Identification
Anna Dominika Wojtylko 1, Hanna Garnier 2, Edyta Jedrzejak 1, Malgorzata Rapala 1, Maciej Murawski 2, Marzena Kozakiewicz 1, Piotr Czauderna 2, Jan Godzinski 1
1 Department of Pediatric Surgery, Marciniak Specialist Hospital, Wroclaw, Poland
2 Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk. 80- 803 Gdańsk, Nowe Ogrody 1-6, Poland
Indocyanine green (ICG) fluorescence imaging has become an innovative technique in oncologic surgery, particularly for renal tumors, by enhancing the visualization of sentinel lymph nodes (SLNs). Accurate SLN identification is crucial for staging, and biopsy of at least 6–7 regional lymph nodes remains a key component of renal tumor management. Compared to conventional methods, ICG provides superior contrast, potentially reducing the need for reoperations and leading to improved staging accuracy and survival outcomes. Nevertheless, the lack of standardized protocols for ICG dosing and timing limits its diagnostic consistency.
A dual-center study conducted in Wroclaw and Gdańsk (Poland) examined 20 pediatric patients undergoing either nephron-sparing surgery (NSS; n=14) or nephrectomy (n=6) where lymphatic mapping was unclear. In each case, 0.2 ml of ICG was injected intraoperatively into four healthy parenchymal sites, 1–2 cm from the tumor margin, immediately following kidney exposure and prior to vascular pedicle dissection. The results revealed varying degrees of visualization effectiveness.
Optimal lymph node visualization was achieved in one benign cyst and eight nephroblastoma cases (6 NSS, 2 nephrectomies). ICG failed to detect lymph nodes in cases of chromophobe carcinoma and renal cell carcinoma. All fluorescent tissues identified intraoperatively were confirmed histologically as lymphoid structures. Postoperative evaluations showed normal renal perfusion and creatinine levels across all patients. Delayed peritoneal drainage (>4 days post-NSS in 2 cases) and blood transfusions (4 cases) were linked to surgical complexity, not ICG use. No adverse reactions to ICG were reported. Although ICG use slightly extended surgical time in both NSS and nephrectomy procedures, this increase did not exceed 5%.
The findings underscore the importance of further research aimed at optimizing ICG protocols—particularly dosage and timing—and highlight the value of specialized training to fully leverage its benefits in pediatric renal oncology