Published in Frontiers in Veterinary Science, this case report by M. Nolff, R. Dennler, and M. Dennler addresses a major challenge in treating canine malignant insulinoma: reliably locating metastatic lymph nodes. Insulinomas are aggressive pancreatic neuroendocrine tumors with a high metastatic rate, most commonly spreading to draining lymph nodes.
Accurate identification of metastatic nodes is difficult because the pancreas drains to multiple lymphatic centers, and affected nodes often appear normal in size and structure. Traditional palpation or visual inspection may miss small or subtle metastatic targets, complicating surgical planning.
This report describes the intraoperative use of indocyanine green (ICG) combined with near-infrared lymphography to visualize lymphatic drainage pathways in real time. After ICG injection, NIR imaging highlighted lymphatic vessels and nodes, allowing surgeons to detect and remove six sentinel lymph nodes.
The authors propose that this technique could form the basis of a more structured approach to lymph node resection in cases of malignant insulinoma. Such an approach may help clinicians overcome the limitations of anatomical variability and subtle metastases.
While promising, the authors emphasize that therapeutic benefits must be evaluated in larger cohorts before the method can be widely recommended. Nonetheless, the case underscores the potential of NIRFL as a minimally invasive, real-time tool for improving oncologic outcomes in veterinary—and possibly human—medicine.
Source: Nolff, M., Dennler, R., & Dennler, M. (2023). Use of Indocyanine Green Near-Infrared Lymphography to Detect Sentinel Lymph Nodes in a Dog with a Malignant Insulinoma: A Case Report. Frontiers in Veterinary Science. Published April 27, 2023.
