Rebecca Knackstedt1, Rafael A Couto1, Jennifer Ko2, Cagri Cakmakoglu1, Daisy Wu3, Brian Gastman4. 1. Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA. 2. Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA. 3. University of Toledo Medical School, Toledo, OH, USA. 4. Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA. gastmab@ccf.org.
Abstract
INTRODUCTION: The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature. METHODS: Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate. RESULTS: Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage. CONCLUSIONS: With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.
INTRODUCTION: The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature. METHODS: Consecutive cutaneous melanomapatients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate. RESULTS: Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage. CONCLUSIONS: With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.
Authors: Danique M S Berger; Nynke S van den Berg; Vincent van der Noort; Bernies van der Hiel; Renato A Valdés Olmos; Tessa A Buckle; Gijs H KleinJan; Oscar R Brouwer; Lenka Vermeeren; Baris Karakullukçu; Michiel W M van den Brekel; Bart A van de Wiel; Omgo E Nieweg; Alfons J M Balm; Fijs W B van Leeuwen; W Martin C Klop Journal: J Nucl Med Date: 2021-02-26 Impact factor: 10.057
Authors: Friso B Achterberg; Babs G Sibinga Mulder; Ruben P J Meijer; Bert A Bonsing; Henk H Hartgrink; J Sven D Mieog; Aimen Zlitni; Seung-Min Park; Arantza Farina Sarasqueta; Alexander L Vahrmeijer; Rutger-Jan Swijnenburg Journal: Ann Transl Med Date: 2020-11
Authors: F B Achterberg; M M Deken; R P J Meijer; J S D Mieog; J Burggraaf; C J H van de Velde; R J Swijnenburg; A L Vahrmeijer Journal: Eur J Nucl Med Mol Imaging Date: 2020-08-12 Impact factor: 9.236