title: Indocyanine green-assisted sentinel lymph node biopsy in melanoma using the "FOVIS" system.
abstract: BACKGROUND
  Metastatic involvement of the sentinel lymph node (SLN) represents a key prognostic factor in melanoma. The combined use of a radiocolloid (technetium-99m) and blue dye is the gold standard in sentinel lymph node biopsy (SLNB). In this context, near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has been suggested as an alternative. The objective of the present study was to examine the potential advantages of fluorescence-guided SLNB - compared to the conventional method - with respect to the visualization of lymphatic drainage pathways and the SLN. Particular focus was on the impact of the ICG dose used and the body mass index (BMI).
  
  
  METHODS
  The study included ten patients who underwent the SLNB procedure using technetium-99m, blue dye, and ICG. Real-time fluorescence imaging of lymphatic drainage pathways and the SLN was done using the "FOVIS"-NIR system. Depending on the quality of the images achieved, ICG was intradermally administered at a dose ranging from 0.25 to 2.5 mg.
  
  
  RESULTS
  Nine SLNs were identified by fluorescence (90 %); (100 %) ten, by gamma probe; eight (80 %), by ICG or blue dye. Transdermal SLN detection was possible in one case (10 %). In correlation to the BMI, higher intradermal ICG doses - up to 2.5 mg overall - proved to be advantageous in the visualization of lymphatic vessels.
  
  
  CONCLUSIONS
  Supplementing the technetium-99m method, fluorescence SLNB using ICG and the "FOVIS"-NIR system is a safe alternative to the blue-dye technique. Further studies on the optimal ICG dose and transdermal imaging in correlation to the BMI are required.
authors.affiliation: Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Daniela
authors.initials: D
authors.lastname: Göppner
authors.affiliation: Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Nekwasil
authors.affiliation: Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Jellestad
authors.affiliation: W.O.M. WORLD OF MEDICINE GmbH, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Sachse
authors.affiliation: W.O.M. WORLD OF MEDICINE GmbH, Berlin, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Schönborn
authors.affiliation: Department of Dermatology and Venereology, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Gollnick
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D008856:Microscopy, Fluorescence / Q000295:instrumentation*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D000071036:Sentinel Lymph Node / Q000000981:diagnostic imaging / Q000473:pathology*; D021701:Sentinel Lymph Node Biopsy / Q000295:instrumentation* / Q000379:methods; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D007208:Indocyanine Green