title: Indocyanine green SPY elite-assisted sentinel lymph node biopsy in cutaneous melanoma.
abstract: BACKGROUND
  Sentinel lymph node biopsy is the standard of care for intermediate-depth and high-risk thin melanomas. Recently, indocyanine green and near-infrared imaging have been used to aid in sentinel node biopsy. The present study aimed to determine the feasibility of sentinel lymph node biopsy with indocyanine green SPY Elite navigation and to critically evaluate the technique compared with the standard modalities.
  
  
  METHODS
  A retrospective review of 90 consecutive cutaneous melanoma patients who underwent sentinel lymph node biopsy was performed. Two cohorts were formed: group A, which had sentinel lymph node biopsy performed with blue dye and radioisotope; and group B, which had sentinel lymph node biopsy performed with radioisotope and indocyanine green SPY Elite navigation. The cohorts were compared to assess for differences in localization rates, sensitivity and specificity of sentinel node identification, and length of surgery.
  
  
  RESULTS
  The sentinel lymph node localization rate was 79.4 percent using the blue dye method, 98.0 percent using the indocyanine green fluorescence method, and 97.8 percent using the radioisotope/handheld gamma probe method. Indocyanine green fluorescence detected more sentinel lymph nodes than the vital dye method alone (p = 0.020). A trend toward a reduction in length of surgery was noted in the SPY Elite cohort.
  
  
  CONCLUSIONS
  Sentinel lymph node mapping and localization in cutaneous melanoma with the indocyanine green SPY Elite navigation system is technically feasible and may offer several advantages over current modalities, including higher sensitivity and specificity, decreased number of lymph nodes sampled, decreased operative time, and potentially lower false-negative rates.
  
  
  METHODS
  Diagnostic, II.
authors.affiliation: Cleveland, Ohio; and Buffalo, N.Y. From the Department of Plastic Surgery, Cleveland Clinic Foundation; and the School of Medicine and Biomedical Sciences, University at Buffalo.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Korn
authors.forename: Alejandra
authors.initials: A
authors.lastname: Tellez-Diaz
authors.forename: Marisa
authors.initials: M
authors.lastname: Bartz-Kurycki
authors.forename: Brian
authors.initials: B
authors.lastname: Gastman
mesh_terms: D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005240:Feasibility Studies; D005260:Female; D005456:Fluorescent Dyes; D006258:Head and Neck Neoplasms / Q000473:pathology; D006801:Humans; D007208:Indocyanine Green; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000473:pathology*; D008875:Middle Aged; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation / Q000379:methods*; D012878:Skin Neoplasms / Q000473:pathology*
chemical_list: D004396:Coloring Agents; D005456:Fluorescent Dyes; D007208:Indocyanine Green