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ICG-Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Reducing the False Negative Rate
Rebecca Knackstedt MD PhD, Brian Gastman MD
Cleveland Clinic
2020-01-08
Presenter: Rebecca Knackstedt
Affidavit:
Yes
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
In melanoma, sentinel lymph node (SLN) status is the best predictor of disease-free survival. The majority of studies examining sentinel lymph node biopsy (SLNB) in melanoma are retrospective with inadequate sample size and follow-up, making calculation of false negative rate (FNR) difficult. In melanoma, the FNR is as high as 29.8%.
Methods
Consecutive primary melanoma patients who underwent radioisotope lymphocintigraphy and ICG-based fluorescence imaging for SLNB from 2012-2018 were prospectively enrolled. FNR was calculated as FN/TP+FN.
Results
594 melanomas were analyzed. There were 130 T1a, 114 T1b, 148 T2a, 34 T2b, 46 T3a, 56 T3b, 22 T4a and 43 T4b. At least one SLN was identified in every patient. 1827 nodes were sampled. 1556 (85.2%) were identified by radioactivity/fluorescence, 255 (14%) by radioactivity only and 16 (0.9%) by fluorescence only. There were 163 positive SLNs. 147 (90.2%) were identified by radioactivity/fluorescence, 13 (8%) by radioactivity only and 3 (0.6%) by fluorescence only. Of the 128 true positive patients, 8 (6.3%) had their only positive node identified by radioactivity only and 4 (3.4%) with fluorescence only. There were 12 false negative patients. The FNR was 8.6%. Mean follow up was 1030.9 days.
Conclusions
In the study of the largest cohort of patients with primary cutaneous melanoma who underwent a SLNB with lymphocintigraphy and ICG technology, we demonstrate the lowest reported FNR amongst comparable studies. This has important implications as the adoption of this technique with subsequent accurate staging, adjuvant work-up and treatment may improve survival outcomes.
