Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial

Carvalho, Carlos Eduardo Barbosa de; Capuzzo, Renato de Castro; Crovador, Camila Souza; Teixeira, Renan J; Laus, Ana Carolina; Carvalho, André Lopes; Vazquez, Vinícius de Lima

doi:10.1245/s10434-020-08409-6

Cited by 8 publications

(4 citation statements)

References 25 publications

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“…Nonetheless, we chose this study design because we believe that ICG can be of additive value to a radiocolloid, but is not its replacement. 15 , 18 – 20 99m technetium nanocolloid is known to stain the SLN, so an advantage of ICG coupled with 99m technetium nanocolloid is that they both stain the SLN. Uncoupled ICG, however, travels easily to subsequent lymph nodes, increasing the chance of missing the SLN and unnecessary removal of non-SLNs.…”

Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Procedure in Pediatric Patients with Melanoma, Squamous Cell Carcinoma, or Sarcoma Using Near-Infrared Fluorescence Imaging with Indocyanine Green: A Feasibility Trial

et al. 2023

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Background Standard sentinel lymph node procedure (SNP) in pediatric cancer consists of a preoperative injection with 99mtechnetium nanocolloid in combination with an optional intraoperative injection with blue dye. However, blue dye has disadvantages, and the detection rate is low, with only 60% of sentinel lymph nodes (SLNs) staining blue. In adult oncology, fluorescence imaging using indocyanine green (ICG) has been shown to be a safe and accurate method for visual detection of SLNs, with a higher sensitivity (up to 97%) compared with blue dye. Therefore, our aim is to determine the feasibility of the addition of ICG to 99mtechnetium nanocolloid (ICG–TC) for visual detection of SLN in pediatric patients. Methods A total of 15 pediatric patients with melanoma, squamous cell carcinoma, and sarcoma were prospectively included. Preoperatively, patients were injected with ICG–TC and imaging with lymphoscintigraphy and single-photon emission computed tomography– computed tomography was performed. Intraoperatively, SLN was detected with fluorescence and the gamma probe. Postoperatively, fluorescence was quantified by tumor-to-background ratio (TBR) and surgeons evaluated the use of ICG using a standardized questionnaire. Results In 10/15 (67%) patients, SLNs were visible transcutaneously. Of all intraoperatively detected SLNs, 35/37 (95%) were fluorescent and 37/37 (100%) were radioactive. Furthermore, ICG–TC led to the identification of six additional SLNs as compared with preoperative imaging. The median TBR in vivo was 6.5 (IQR 5.3). The surgical evaluation showed that ICG assisted in SLN detection and was easy to use. Conclusions ICG–TC for the SNP is a feasible procedure in pediatric patients. It showed an accurate detection rate, was helpful for visual guidance, and no adverse events occurred.

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Section: Discussionmentioning

confidence: 99%

Sentinel Lymph Node Procedure in Pediatric Patients with Melanoma, Squamous Cell Carcinoma, or Sarcoma Using Near-Infrared Fluorescence Imaging with Indocyanine Green: A Feasibility Trial

et al. 2023

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“…Caution should be taken when deciding to use ICG alone. De Carvalho et al compared RI, ICG, and BDs independently and found that RI alone was the only method of SLN detection that could stand alone with an SLN detection rate of 92.6% compared to ICG (70.2%), BDs (76.9%), and all three together (95.95%) [ 13 ]. The implications of this data are limited, however, the authors state that they were unable to adequately evaluate lesions of the head and neck.…”

Section: Discussionmentioning

confidence: 99%

Detection of Sentinel Lymph Nodes Using Indocyanine Green After Failing Scintigraphy in Merkel Cell Carcinoma

Smith¹,

Ferri²,

Frieder³

et al. 2023

Cureus

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Merkel cell carcinoma (MCC) is a rare but highly aggressive skin cancer that carries a high rate of lymph node involvement and death. The National Comprehensive Cancer Network recommends sentinel lymph node (SLN) biopsy for the staging of the disease. Scintigraphy using radioactive isotopes (RI) such as technetium 99m (Tc99) remains the gold standard for the detection of SLNs, however, recently indocyanine green (ICG) fluorescence imaging has been used to aid in the detection of SLNs.We present the case of a patient who presented with MCC of the face and two SLNs successfully identified with ICG fluorescence despite the fact that they were not detected by intraoperative scintigraphy using Tc99. The use of ICG fluorescence imaging in MCC is safe and improves the ability to detect SLNs when combined with RI.

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“…(35) However, another recent prospective study of 121 melanoma patients demonstrated that the combination of lymphoscintigraphy, probe and ICG fluorescence improved the SN detection rate only marginally. (36) In addition to the introduction of new detection techniques and advancing surgical skills, the more elaborate histopathological examination plays an important role in the sensitivity of SLNB. After increasing the number of levels of examination of SNs from 3 to 6 in 2014, the number of FN procedures dropped from 8 in 193 patients to none in the subsequent 84.…”

Section: Discussionmentioning

confidence: 99%

Technologic (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region

et al. 2021

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BackgroundSentinel lymph node (SN) biopsy (SLNB) has proven to be a valuable tool for staging melanoma patients.Since its introduction in the early 1990s, this procedure has undergone several technological refinements, including the introduction of single photon emission computed tomography combined with computed tomography (SPECT/CT) as well as radio-and fluorescence-guidance. The purpose of the current study was to evaluate the effect of this technological evolution on SLNB in the head and neck region. Primary endpoint was the false-negative (FN) rate. Secondary endpoints were number of harvested SNs, overall operation time, operation time per harvested SN and postoperative complications. Patients and MethodsA retrospective database was queried for cutaneous head and neck melanoma patients who underwent SLNB at The Netherlands Cancer Institute between 1993 and 2016. The implementation of new detection techniques was divided in 4 groups: (1) 1993-2005, with preoperative lymphoscintigraphy and intraoperative use of both a gamma ray detection probe and patent blue (n=30); (2) 2006-2007, with addition of preoperative roadmaps based on SPECT/CT (n=15); (3) 2008-2009, with intraoperative use of a portable gamma camera (n=40); and (4) 2010-2016, with the addition of near-infrared fluorescence guidance (n=192). ResultsA total of 277 patients were included. At least one SN was identified in all patients. A tumor-positive SN was found in 59 patients (21.3%), 10 in group 1 (33.3%), 3 in group 2 (20.0%), 6 in group 3 (15.0%) and 40 in group 4 (20.8%). Regional recurrences of patients with tumor-negative SNs resulted in an overall FN rate of 11.9% (FN groups 1: 16.7%; 2: 0%; 3: 14.3%; 4: 11.1%). The number of harvested nodes increased with advancing technologies (p=0.003) whereas Breslow thickness and operation time per harvested SN decreased (p=0.003 and p=0.017, respectively). There was no significant difference in percentage of tumor-positive SNs, overall operation time and complication rate between the different groups. ConclusionThe use of advanced detection technologies led to a higher number of identified SNs without increase in overall operation time, which may indicate an improved surgical efficiency. Operation time per harvested SN decreased, the average FN rate remained 11.9% and unchanged over 23 years. There was no significant change in postoperative complication rate.

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Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial

Cited by 8 publications

References 25 publications

Sentinel Lymph Node Procedure in Pediatric Patients with Melanoma, Squamous Cell Carcinoma, or Sarcoma Using Near-Infrared Fluorescence Imaging with Indocyanine Green: A Feasibility Trial

Sentinel Lymph Node Procedure in Pediatric Patients with Melanoma, Squamous Cell Carcinoma, or Sarcoma Using Near-Infrared Fluorescence Imaging with Indocyanine Green: A Feasibility Trial

Detection of Sentinel Lymph Nodes Using Indocyanine Green After Failing Scintigraphy in Merkel Cell Carcinoma

Technologic (R)Evolution Leads to Detection of More Sentinel Nodes in Patients with Melanoma in the Head and Neck Region

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