Melanoma

Indocyanine Green Fluorescence-Based Technology for Sentinel Lymph Node Biopsy in Primary Head and Neck Melanoma

Head and neck melanoma is associated with a high false negative (FN) sentinel lymph node biopsy (SLNB) rate. The false negative rate is defined by the number of false negative biopsies divided by false negative biopsies plus true positive biopsies. Institute physicians previously demonstrated that the combination of lymphoscintography and indocyanine green (ICG) fluorescence-based technology was feasible for SLNB in primary melanoma.¹⁻⁴ If techniques are developed that can decrease FN SLNBs, better prognostic information will be obtained, which may improve overall survival as patients are assigned to the appropriate adjuvant management.

Consecutive head and neck cutaneous melanoma patients who underwent radioisotope lymphocintigraphy and ICG-based fluorescence imaging by a single surgeon from 2012–2015 were prospectively enrolled for analysis and followed by a multidisciplinary melanoma team. Main outcome variables were the FN rate of SLNB. Length of follow-up was date of surgery to the date of last follow-up or death. The study demonstrates that concomitant gamma probe-based radioactivity detection and ICG-based fluorescence for SLN identification in head and neck melanoma is reliable, reproducible and thus far, has produced a low rate of false negative SLNB.

There were ten positive SLNB, 50 true negative SLNB and one false negative SLNB. The FN rate was 9.1%, FN incidence was 1.6%, sensitivity was 91% and specificity was 100%. Mean follow-up was 27.6, 17.6 and 16.5 months for true negative, true positive, and false negative patients, respectively.

Patient and Melanoma Characteristics (N = 60)

2012 - 2015

References
  1. Aziz, HA, Gastman BR, Singh AD. Management of conjunctival melanoma: critical assessment of sentinel lymph node biopsy. Ocul Oncol Pathol. 2015; 1(4):266-273.

  2. Couto RA, Lamaris GA, Knackstedt R, Alleyne B, Durand P, Rueda S, Gastman B. Determining the false-negative rate using fluorescence image-assisted sentinel lymph node biopsy in cutaneous melanoma. Ann Plast Surg. 2018; 80(1):54-58.

  3. Korn JM, Telez-Diaz A, Bartz-Kurycki M, Gastman B. Indocyanine green SPY elite-assisted sentinel lymph node biopsy in cutaneous melanoma. Plast Reconstr Surg. 2014; 133(4):914-922.

  4. Rubinstein TJ, Perry JD, Korn JM, Costin BR, Gastman BR, Singh AD. Indocyanine green-guided sentinel lymph node biopsy for periocular tumors. Ophthal Plast Reconstr Surg. 2014;30(4):301-304.