Clinical Report: Fluorescence-Guided Laparoscopic Biopsy in Abdominal Lymphoma
Overview
The FLABILY trial investigates the use of indocyanine green (ICG) fluorescence guidance to improve laparoscopic lymph node biopsy (LLB) in abdominal lymphoma. Early data suggest that ICG facilitates identification of pathological lymph nodes, potentially enhancing biopsy accuracy and surgical decision-making.
Background
Laparoscopic lymph node biopsy is a critical procedure for diagnosing and classifying abdominal lymphomas, offering superior tissue sampling compared to needle biopsy. However, locating small or anatomically challenging lymph nodes can be difficult. Near-infrared fluorescence imaging with ICG has emerged as a promising intraoperative tool to improve visualization of lymphatic tissue. The FLABILY study was launched to evaluate the efficacy of fluorescence-guided laparoscopic lymph node biopsy (FGLLB) in primary lymphoproliferative diseases.
Data Highlights
Parameter
Details
Study Design
Multicentre observational study (FLABILY)
Enrollment
Patients ≥18 years with abdominal lymphadenopathy requiring biopsy
ICG Dosage
3.75–5 mg intradermal/intranodal or 2 ml intraperitoneal depending on LN location
Injection Timing
30 minutes to several hours preoperatively for sub-mesocolic; intraoperative for supra-mesocolic
Imaging System
Visera Elite II with infrared light source and UHD telescope
Outcome Measures
Operative time, blood loss, complications, fluorescence detection rate
Key Findings
ICG demonstrates elective tropism for pathological lymph nodes in primary lymphoproliferative disease, aiding intraoperative localization.
Injection site and timing vary by anatomical lymph node location to optimize fluorescence visualization.
Fluorescence guidance facilitates targeted biopsy of lymph nodes with highest PET/CT standardized uptake values (SUV), potentially improving diagnostic yield.
The minimally invasive FGLLB approach under fluorescence guidance is safe and feasible with low complication rates.
Fluorescence imaging may reduce operative time and the need for additional trocars or surgical conversion by improving lymph node identification.
Clinical Implications
Fluorescence-guided laparoscopic biopsy using ICG can enhance the surgeon's ability to locate and sample pathological abdominal lymph nodes accurately, especially in challenging anatomical regions. This technique may improve diagnostic accuracy and reduce operative complexity in lymphoma management. Tailoring ICG injection protocols based on lymph node location is important for optimal fluorescence visualization.
Conclusion
The FLABILY trial supports the utility of ICG fluorescence guidance in laparoscopic lymph node biopsy for abdominal lymphoma, offering a promising adjunct to improve surgical precision and diagnostic outcomes. Further data from ongoing study enrollment will clarify optimal protocols and long-term benefits.
by Marco Casaccia, Giovanni Alemanno, Paolo Prosperi, Graziano Ceccarelli, Stefano Olmi, Alberto Oldani, Mauro Santarelli, Roberta Tutino, Franco De Cian
