title: Sentinel lymph node detection using laser-assisted indocyanine green dye lymphangiography in patients with melanoma.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY 11794-8191, USA.
authors.forename: Vikalp
authors.initials: V
authors.lastname: Jain
authors.affiliation: Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY 11794-8191, USA.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Phillips
authors.affiliation: Stony Brook School of Medicine, Stony Brook University Medical Center, Stony Brook, NY 11794, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Conkling
authors.affiliation: Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY 11794-8191, USA.
authors.forename: Colette
authors.initials: C
authors.lastname: Pameijer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D006801:Humans; D007208:Indocyanine Green; D054025:Lasers, Dye; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology; D008220:Lymphography / Q000379:methods; D008545:Melanoma / Q000000981:diagnostic imaging* / Q000473:pathology; D008751:Methylene Blue; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D013667:Technetium
chemical_list: D004396:Coloring Agents; D013667:Technetium; D007208:Indocyanine Green; D008751:Methylene Blue