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Determining the False Negative Rate Using Indocyanine Green Guided Sentinel Lymph Node Biopsy in Cutaneous Melanoma; Experience with over 400 Patients
Rebecca Knackstedt MD PhD; Rafael A. Couto MD; Daisy Wu BS; Brian Gastman MD
Cleveland Clinic
2019-01-17
Presenter: Rebecca Knackstedt
Affidavit:
I confirm
Director Name: Steven Bernard
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Surgical management for cutaneous melanoma involves surgical excision with or without a sentinel lymph node biopsy (SNLB). A false negative sentinel node can result in inappropriate post-surgical work-up, staging and adjuvant treatment. Our group previously demonstrated lymphoscintography and indocyanine green fluorescence-based technology was feasible for sentinel lymph node biopsy in primary melanoma.
Methods
Consecutive cutaneous melanoma patients who underwent radioisotope lymphocintigraphy and ICG-based fluorescence imaging by the senior author from 2012-2017 were prospectively enrolled . Charts were reviewed for patient and melanoma characteristics, operative technique and findings, pathological data and outcomes
Results
405 consecutive patients were analyzed. 324 (80%) patients had a negative SNLB and 81 (20%) had a positive SLNB. Eight patients who initially had a negative SLNB recurred in the nodal basin. Two patients experienced a local recurrence and three experienced in-transit metastasis in conjunction with the nodal recurrence. 316 (78%) patients had true negative SLNB, 81 (20%) patients had true positive SLNB and 8 (2%) patients had a false negative SLNB. This resulted in a FNI of 2% and FNR of 9% 374 (88.6%) patients were alive and 31 (7.7%) were deceased. Mean and median follow-up were 33.4 and 28.7 months, respectively.
Conclusions
This is the largest cohort of patients reported with cutaneous melanoma who underwent SLNB with the combination of lymphoscintography and indocyanine green (ICG) fluorescence-based technology. Our results demonstrate that radioactive and ICG based technology for SLN identification in cutaneous melanoma is reliable, reproducible and has produced a low false negative SLNB rate.
