Background/Objectives: This study evaluated the impact of fluorescence lymph node mapping (FLNM) using indocyanine green (ICG) on the diagnostic accuracy of preoperative computed tomography (CT) in right-sided colon cancer. Methods: A total of 218 patients who underwent laparoscopic right hemicolectomy with D3 lymph node dissection (LND) were analyzed: 86 patients in the FLNM group and 132 in the conventional surgery group. The FLNM technique allowed for enhanced intraoperative visualization of lymph node (LN) and more precise dissection, improving the identification of metastatic LNs. The diagnostic value of preoperative CT staging was assessed in both the FLNM and control groups by calculating the apparent prevalence, true prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value, positive likelihood ratio (PLR), negative likelihood ratio, false positive and false negative proportions, and accuracy. Results: FLNM increased the accuracy of CT staging for detecting D3 LN metastasis in advanced cancer cases, with a higher PPV, PLR, and accuracy. In the FLNM group, the false-positive rate was significantly reduced, and the specificity was higher compared to the control group. Multivariate analysis identified FLNM as an independent factor associated with improved D3 LN metastasis detection. These findings suggest that incorporating FLNM into surgical procedures enhances the diagnostic value of preoperative CT by improving the precision of LND, particularly in patients with advanced colon cancer. Conclusions: The use of FLNM for D3 LND enhances the diagnostic accuracy of cN staging in right-sided colon cancer by improving surgical precision.
背景/目的：本研究旨在评估吲哚菁绿荧光淋巴结示踪技术在右半结肠癌中对术前计算机断层扫描诊断准确性的影响。方法：共纳入218例接受腹腔镜右半结肠癌D3淋巴结清扫术的患者进行分析，其中荧光示踪组86例，传统手术组132例。荧光示踪技术通过术中增强淋巴结可视化实现更精准的清扫，从而提升转移性淋巴结的检出率。通过计算表观患病率、真实患病率、敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比、假阳性率、假阴性率及准确度等指标，系统评估荧光示踪组与对照组中术前CT分期的诊断效能。结果：在进展期癌症病例中，荧光示踪技术显著提升了CT对D3淋巴结转移的检测准确度，表现为更高的阳性预测值、阳性似然比及总体准确度。与对照组相比，荧光示踪组的假阳性率显著降低，特异性更高。多变量分析证实荧光示踪是改善D3淋巴结转移检测的独立影响因素。这些发现表明，将荧光示踪技术整合到手术过程中，可通过提高淋巴结清扫的精确度，增强术前CT的诊断价值，尤其对进展期结肠癌患者具有显著意义。结论：在右半结肠癌D3淋巴结清扫中应用荧光示踪技术，可通过提升手术精准度，显著增强临床淋巴结分期的诊断准确性。
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