Table V.
Module 3-Technical aspects of sentinel node identification during gastric cancer surgery
| Statements voted upon | No. of votes | Voting, % | Most common response | No. of rounds | Consensus, % |
|---|---|---|---|---|---|
| Consensus reached | |||||
| ICG should be delivered peritumorally. | 22 | 100 | Agree | 1 | 100 |
| When using ICG for SLN identification, the timing of ICG administration is very important. | 20 | 90.9 | Agree | 1 | 100 |
| Research is necessary to determine the optimum dose and concentration of ICG and timing of administration. | 22 | 100 | Agree | 1 | 100 |
| Four-quadrant peritumoral injection yields OPTIMAL SLN identification. | 20 | 90.9 | Agree | 1 | 95 |
| When using ICG for SLN identification, the dose of ICG is very important. | 19 | 86.4 | Agree | 1 | 94.7 |
| When using ICG for SLN identification, the concentration of ICG administered is very important. | 19 | 86.4 | Agree | 1 | 94.7 |
| There is a role for sentinel BASIN imaging in gastric cancer. | 19 | 86.4 | Agree | 1 | 89.5 |
| Using the “pick-up method” the number of “hot” nodes that can be considered SLNs is (1 node; 2–4 nodes; >4 nodes). | 18 | 90 | 2–4 | 2 | 88.9 |
| The optimal mode of ICG administration when using it for SLN identification is (endoscopicesubmucosal injection; transabdominalesubserosal injection) | 22 | 100 | Endoscopically | 1 | 86.4 |
| If you use radiocolloid, (99m)Tc-colloid or some other agent should be used. | 14 | 70 | 99mTc | 2 | 85.7 |
| ICG should only be administered endoscopically (because of cross-contamination when used transabdominally). | 19 | 95 | Agree | 2 | 84.2 |
| The optimal timing of ICG injection prior to imaging with NIR light for SLNs is (on the same day as surgery; on the previous day). | 19 | 95 | Same day | 2 | 78.9 |
| There is a role for SLN basin identification to decrease the extent of LA and, thereby, the incidence of morbidity from more extensive nodal dissection at low-volume* centers. | 18 | 81.8 | Agree | 1 | 77.8 |
| At 5 mg/ml, the optimum dose of ICG to administer for SLN identification during gastric cancer surgery is (<1 mL; 1–5 mL; >5 mL) | 22 | 100 | 1–5 mL | 1 | 77.3 |
| >4 injection sites are needed to obtain optimal SLN identification. | 19 | 95 | Disagree | 2 | 73.7 |
| If adequate visualization of SLNs is NOT achieved, the dose of ICG should be repeated. | 19 | 95 | Disagree | 2 | 73.7 |
| ICG and FI is an acceptable single-agent modality for SLN identification. | 18 | 81.8 | Agree | 1 | 72.2 |
| For gastrectomies, ICG, and FI should be used for SLN identification, either as a single agent or as part of a dual agent regimen (N, S, M, A)… | 18 | 90 | Sometimes | 2 | 72.2 |
| There is a role for frozen section of SLNs in deciding on the degree of lymphadenectomy in gastric cancer. | 20 | 90.9 | Agree | 1 | 70 |
| No consensus reached | |||||
| The dose of ICG to administer for SLN identification during gastric cancer surgery should be determined as (mg/kg; an absolute dose) | 19 | 95 | Absolute | 2 | 68.4 |
| The best identification of SLNs is achieved with radiocolloid + blue dye, FI+ICG, or radiocolloid + FI+ICG. | 19 | 95 | FI+ICG | 2 | 63.2 |
| IF given on the same day, the optimal timing of ICG injection prior to imaging with NIR light for SLNs is (≤10 min before; 10–30 min before; >30 min before) | 19 | 95 | 11–30 minutes | 2 | 63.2 |
| Relative to its use in open surgery, use of ICG and NIR technology (for SLNs) has a value in laparoscopic procedures (either as a single or dual-agent regimen) that is… | 20 | 100 | ~Same | 2 | 60 |
| ICG and FI should be used as a SINGLE-AGENT for the identification of SLNs, never, sometimes, most times, always. | 19 | 95 | Most times | 2 | 36.8 |
Average consensus = 78.4%.
99mTc, technetium-99m; FI, fluorescence imaging; ICG, indocyanine green; LA, lymphadenectomy; NIR, near-infrared; (N, S, M, A), never, sometimes, most of the time, always; SLN, sentinel lymph node.