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Utilizing the Indocyanine Green Fluorescence Method to Improve Identification of Sentinel Lymph Nodes in Cutaneous Melanoma
Jason M. Korn
Alejandra Tellez,
Marisa Bartz-Kurycki,
Brian R. Gastman
Cleveland Clinic
2013-03-14
Presenter: Jason Korn
Affidavit:
I confirm that the submitted work represents original work of the authors, and that the work has not been submitted or published elsewhere, in whole or in part.
Director Name: Steven Bernard, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Current conventional methods used for sentinel lymph node biopsy (SLNB) have a false negative rate of 13% (0-34%). Recent reports indicate that the addition of fluorescent dye indocyanine green (ICG) may help reduce false negatives. A near-infrared camera that detects ICG fluorescence has recently been used concomitantly with technecium-99m labeled sulfur colloid at our institution.
Methods: A cohort of consecutive SLNB done in patients with cutaneous melanoma, performed by a single surgeon in a tertiary care hospital, between November 2010 to January 2013 were retrospectively reviewed.
Results: 81 SLNB were performed, patients treated prior to April 2012 (N=39) were performed using a combination of radiocolloid/methylene blue (group-1). SLNB done after April 2012 (N=42) were performed with a combination of radiocolloid/ICG-fluorescence (group-2). The detection rates of SLN were 100% (39 ⁄ 39) with radiocolloid/methylene blue methods, and 97.6% (41 ⁄ 42) with radiocolloid/ICG-fluorescence. Within group 2, three out of 42 patients (7.1%) underwent resection of 3 additional SLN detected by ICG-fluorescence only. None of these SLN were positive for metastases. The median number of SLN examined for patients in group-2 was 2 (interquartile range, 1-3). Patients in group-1 had a median of 1 SLN examined (interquartile range, 1-2) (P=0.35).
Conclusions: Our results suggest that intra-operative use of ICG-fluorescence method is effective at identifying additional sentinel lymph nodes in cutaneous melanoma and may potentially offer lower false negative rates. Further prospective studies are required to evaluate the impact of ICG-fluorescence method utilization.
