Sentinel lymph node detection using laser-assisted indocyanine green dye lymphangiography in patients with melanoma

Vikalp Jain, Brett T Phillips, Nicole Conkling, Colette Pameijer, Vikalp Jain, Brett T Phillips, Nicole Conkling, Colette Pameijer

Abstract

Introduction: Sentinel lymph node (SLN) biopsy is a vital component of staging and management of multiple cancers. The current gold standard utilizes technetium 99 (tech99) and a blue dye to detect regional nodes. While the success rate is typically over 90%, these two methods can be inconclusive or inconvenient for both patient and surgeon. We evaluated a new technique using laser-assisted ICG dye lymphangiography to identify SLN.

Methods: In this retrospective analysis, we identified patients with melanoma who were candidates for SLN biopsy. In addition to tech99 and methylene blue, patients received a dermal injection of indocyanine green (ICG). The infrared signal was detected with the SPY machine (Novadaq), and nodes positive by any method were excised.

Results: A total of 15 patients were evaluated, with 40 SLNs removed. Four patients were found to have nodal metastases on final pathology. 100% of these 4 nodes were identified by ICG, while only 75% (3/4) were positive for tech99 and/or methylene blue. Furthermore, none of the nodes missed by ICG (4/40) had malignant cells.

Conclusion: ICG dye lymphangiography is a reasonable alternative for locating SLNs in patients with melanoma. Prospective studies are needed to better ascertain the full functionality of this technique.

Figures

Figure 1
Figure 1
Sentinel nodes imaged with the SPY machine through the skin, prior to incision.
Figure 2
Figure 2
SPY imaging after excision of the sentinel node. The superior object is the SLN. The inferior area is the original chest wall melanoma site.

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Source: PubMed

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