title: Indocyanine green and fluorescence lymphangiography for sentinel lymph node identification in cutaneous melanoma.
abstract: OBJECTIVE
  Sentinel lymph node (SLN) biopsy has become the standard method of determining regional lymph node involvement in cutaneous melanoma. Although traditionally performed via injection of radioisotope tracers and blue dyes, fluorescent lymphangiography with indocyanine green (ICG) is an attractive alternative.
  
  
  METHODS
  Fifty two consecutive patients with cutaneous melanoma of the trunk or extremities underwent SLNB. Preoperative lymphoscintigraphy was performed with technetium-99m sulfur colloid (TSC). Peritumoral intradermal injection of isosulfan blue (ISB) and ICG was then performed. Successful identification of a sentinel lymph node via each modality was then assessed.
  
  
  RESULTS
  A total of 77 lymph nodes were identified from the 52 patients (range 1-3). The majority of melanomas were extremity-based, superficial spreading type, and had SLN localized to the axilla. There were no complications related to IcG administration. Rates of SLN detection were 96.2% for TSC, 59.6% for ISB, and 88.5% for IcG (P < 0.05 for ICG vs ISB). On univariate logistic regression analysis, no factors were found to be associated with failure of ICG.
  
  
  CONCLUSIONS
  Fluorescent lymphangiography using ICG is an effective method of SLN identification in patients with cutaneous melanoma of the trunk and extremities. When ICG and TSC are used in combination, ISB offers no additional advantage and may be safely omitted.
authors.affiliation: Department of Surgery, Stanford University, Stanford, CA.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Cloyd
authors.forename: Irene L
authors.initials: IL
authors.lastname: Wapnir
authors.forename: Blake M
authors.initials: BM
authors.lastname: Read
authors.forename: Susan
authors.initials: S
authors.lastname: Swetter
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Greco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D008198:Lymph Nodes / Q000473:pathology; D061305:Lymphoscintigraphy / Q000379:methods*; D008297:Male; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000175:diagnosis*; D013671:Technetium Tc 99m Sulfur Colloid; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma
chemical_list: D004396:Coloring Agents; D019275:Radiopharmaceuticals; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D013671:Technetium Tc 99m Sulfur Colloid; D007208:Indocyanine Green
keywords: indocyanine green; isosulfan blue; lymphadenectomy; melanoma; nuclear medicine; sentinel lymph node biopsy