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Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial

  • Melanoma
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Sentinel lymph node (SLN) biopsy is the standard care for early detection and staging of lymph node metastasis in melanomas. Radiocolloids (RC) and blue dyes are used for SLN detection. Recently, near infrared (NIR) fluorescence tracing using indocyanine green has been developed as an alternative method for SLN detection. The relatively high tissue penetration depth of several millimeters and the ability to detect low concentrations of tracer both suggest that NIR may have significant advantages over RC and the blue dye methods. The objective of this study was to prospectively compare the performance of all three SLN detection techniques using them sequentially to evaluate the same group of patients.

Methods

One hundred twenty-one primary cutaneous melanoma patients with an indication for SLN biopsy were assigned to the procedure following NIR, blue dye, and RC detection techniques.

Results

No adverse event was reported. SLN was not detected in only 4.1% of cases. In 90.9%, an SLN was identified with NIR, but without any auxiliary technique in only 70.2% of cases. RC detected the SLN in 92.6% of cases. Patent blue was found in the sentinel node in 76.9%. The combination of all three techniques detected an SLN in 95.9% of cases. Metastases were present in 26.7%. The false-negative rate was 8.8%, with a negative predictive value of 91.2%.

Conclusions

RC was the only technique with high SLN detection. Both the blue dye and NIR methods added sensitivity to the detection rate but should not be a substitute for RC.

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Acknowledgment

The authors would like to express their sincere thanks to the Sao Paulo Research Foundation (FAPESP) for its funding of this research (Grant # 12/07459-6 for AL Carvalho) and the Research Support Department of the Barretos Cancer Hospital. The authors also thank Dr. Jeremy Squire for English evaluation and for his critical review of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Melanoma and Sarcoma, Barretos Cancer Hospital, Barretos, SP, Brazil

    Carlos Eduardo Barbosa de Carvalho M.D. & Vinicius L. Vazquez M.D., Ph.D

  2. Department of Head and Neck, Barretos Cancer Hospital, Barretos, SP, Brazil

    Renato Capuzzo M.D., MSc.

  3. Institute of Education and Research, Barretos Cancer Hospital, Barretos, SP, Brazil

    Camila Crovador RN, MSc., Renan J. Teixeira PT, Ana Carolina Laus Ph.D, Andre Lopes Carvalho M.D., Ph.D & Vinicius L. Vazquez M.D., Ph.D

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  1. Carlos Eduardo Barbosa de Carvalho M.D.
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  2. Renato Capuzzo M.D., MSc.
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  3. Camila Crovador RN, MSc.
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  4. Renan J. Teixeira PT
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  5. Ana Carolina Laus Ph.D
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  6. Andre Lopes Carvalho M.D., Ph.D
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  7. Vinicius L. Vazquez M.D., Ph.D
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Correspondence to Vinicius L. Vazquez M.D., Ph.D.

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The authors declare no conflicts of interests in the conduction of this work. This work was supported by Sao Paulo Research Foundation (FAPESP) and by The Barretos Cancer Hospital.

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de Carvalho, C.E.B., Capuzzo, R., Crovador, C. et al. Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial. Ann Surg Oncol 27, 2906–2912 (2020). https://doi.org/10.1245/s10434-020-08409-6

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  • DOI: https://doi.org/10.1245/s10434-020-08409-6

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