International Journal of Clinical Oncology

, Volume 19, Issue 1, pp 198–203 | Cite as

Limitation of indocyanine green fluorescence in identifying sentinel lymph node prior to skin incision in cutaneous melanoma

  • Kenjiro Namikawa
  • Arata Tsutsumida
  • Ryota Tanaka
  • Junji Kato
  • Naoya Yamazaki
Original Article

Abstract

Background

Although several reports have discussed the potential of the indocyanine green (ICG) fluorescence technique, its effectiveness and limitations have not been fully evaluated. For the accurate detection of sentinel lymph node (SLN) in cutaneous melanoma, which can arise in a wide variety of sites throughout the body, it is important to detect the SLN sites prior to skin incision. The purpose of this study was to evaluate the ICG fluorescence technique in the preoperative setting.

Patients and methods

We classified the detection process of SLN biopsy into three surgical stages: ‘before skin incision,’ ‘after skin incision,’ and ‘ex vivo.’ We retrospectively reviewed 93 node fields in 86 patients who underwent SLN biopsies using ICG and conventional techniques.

Results

The detection rate using ICG at the ‘before skin incision,’ ‘after skin incision,’ and ‘ex vivo’ surgical stages were 63.4, 98.9, and 100 %, respectively. At the ‘before skin incision’ surgical stage, while lymphoscintigraphy (but not ICG) detected 33 node fields, ICG (but not lymphoscintigraphy) detected only four node fields. The detection rates varied from 100 % in the groin region drained from trunk to 15.8 % in the axillary region from upper limb. The factors that influenced the failure of ICG to identify hot SLNs were an axillary node field (p < 0.001) and a high body mass index (BMI) (p = 0.046).

Conclusion

For reliable identification of SLNs in cutaneous melanoma, the ICG fluorescence technique may offer little benefit for patients with axillary node field drained from upper limb, or high BMI.

Keywords

Axilla Body mass index Indocyanine green fluorescence Melanoma Sentinel lymph node biopsy 

References

  1. 1.
    Murawa D, Hirche C, Dresel S et al (2009) Sentinel lymph node biopsy in breast cancer guided by indocyanine green fluorescence. Br J Surg 96:1289–1294PubMedCrossRefGoogle Scholar
  2. 2.
    Hojo T, Nagao T, Kikuyama M et al (2010) Evaluation of sentinel node biopsy by combined fluorescent and dye method and lymph flow for breast cancer. Breast 19:210–213PubMedCrossRefGoogle Scholar
  3. 3.
    Namikawa K, Yamazaki N (2011) Sentinel lymph node biopsy guided by indocyanine green fluorescence for cutaneous melanoma. Eur J Dermatol 21:184–190PubMedGoogle Scholar
  4. 4.
    Fujisawa Y, Nakamura Y, Kawachi Y et al (2012) Indocyanine green fluorescence-navigated sentinel node biopsy showed higher sensitivity than the radioisotope or blue dye method, which may help to reduce false-negative cases in skin cancer. J Surg Oncol 106:41–45PubMedCrossRefGoogle Scholar
  5. 5.
    Hayashi T, Furukawa H, Oyama A et al (2012) Sentinel lymph node biopsy using real-time fluorescence navigation with indocyanine green in cutaneous head and neck/lip mucosa melanomas. Head Neck 34:758–761PubMedCrossRefGoogle Scholar
  6. 6.
    Polom K, Murawa D, Rho YS et al (2011) Current trends and emerging future of indocyanine green usage in surgery and oncology: a literature review. Cancer 117:4812–4822PubMedCrossRefGoogle Scholar
  7. 7.
    Uhara H, Takata M, Saida T (2009) Sentinel node biopsy in Japan. Int J Clin Oncol 14:490–496PubMedCrossRefGoogle Scholar
  8. 8.
    Namikawa K, Yamazaki N, Nakai Y et al (2012) Prediction of additional lymph node positivity and clinical outcome of micrometastases in sentinel lymph nodes in cutaneous melanoma: a multi-institutional study of 450 patients in Japan. J Dermatol 39:130–137PubMedCrossRefGoogle Scholar
  9. 9.
    Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:392–399PubMedCrossRefGoogle Scholar
  10. 10.
    Albertini JJ, Cruse CW, Rapaport D et al (1996) Intraoperative radio-lympho-scintigraphy improves sentinel lymph node identification for patients with melanoma. Ann Surg 223:217–224PubMedCrossRefGoogle Scholar
  11. 11.
    Balch CM, Morton DL, Gershenwald JE et al (2009) Sentinel node biopsy and standard of care for melanoma. J Am Acad Dermatol 60:872–875PubMedCrossRefGoogle Scholar
  12. 12.
    Liu LC, Parrett BM, Jenkins T et al (2011) Selective sentinel lymph node dissection for melanoma: importance of harvesting nodes with lower radioactive counts without the need for blue dye. Ann Surg Oncol 18:2919–2924PubMedCrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2013

Authors and Affiliations

  • Kenjiro Namikawa
    • 1
  • Arata Tsutsumida
    • 1
  • Ryota Tanaka
    • 1
  • Junji Kato
    • 1
  • Naoya Yamazaki
    • 1
  1. 1.Department of Dermatology and Dermatologic OncologyNational Cancer Center HospitalTokyoJapan

Personalised recommendations