Annals of Surgical Oncology

, Volume 26, Issue 11, pp 3550–3560 | Cite as

Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate

  • Rebecca Knackstedt
  • Rafael A. Couto
  • Jennifer Ko
  • Cagri Cakmakoglu
  • Daisy Wu
  • Brian GastmanEmail author



The goal of this study was to analyze patients who underwent a sentinel lymph node biopsy (SLNB) in melanoma with the combination of radioisotope lymphoscintigraphy and indocyanine green (ICG) fluorescence imaging to compare our true positive (TP) rate, a means to perform immediate analysis of the SLNB, with that of the literature.


Consecutive cutaneous melanoma patients who underwent SLNB with lymphoscintigraphy and ICG-based fluorescence imaging by the senior author (BG) from 2012 to 2018 were prospectively enrolled. The average expected SLN-positive rate per T stage was calculated based on three studies and compared with our SLN-positive rate.


Overall, 574 consecutive patients were analyzed. Average Breslow thickness was 1.9 mm. A total of 1754 sentinel nodes were sampled; 1497 were identified by gamma probe signaling and ICG, 241 were identified by gamma probe signaling only, and 16 were identified by ICG only. There were 123 (21.4%) patients with at least one positive SLN; 113 (91.9%) had at least one positive node identified with both gamma probe signaling and ICG, 8 (6.5%) had positive node(s) identified with gamma probe signaling only, and 2 (1.6%) had positive node(s) identified with ICG only. There was an overall 21.4% SLN-positive rate, with 8% T1, 18.5% T2, 41.1% T3, and 52.4% T4, which is higher than the predicted rates for each stage.


With the largest cohort of patients reported who underwent a melanoma SLNB with lymphoscintigraphy and ICG, we demonstrated that this technique results in higher SLN-positive rates than predicted. Patients are being followed but, given the TP data, knowledge of our results may foster the use of this modality to improve staging and treatment options.


Author Contributions

Study design was undertaken by BG. All authors contributed to data collection and analysis, and writing of the manuscript.

Conflicts of interest

Brian Gastman is a consultant for Quest Diagnostics.


The authors have no disclosures to report.

Supplementary material

Supplementary material 1 (MPG 19150 kb)


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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Rebecca Knackstedt
    • 1
  • Rafael A. Couto
    • 1
  • Jennifer Ko
    • 2
  • Cagri Cakmakoglu
    • 1
  • Daisy Wu
    • 3
  • Brian Gastman
    • 1
    Email author
  1. 1.Department of Plastic and Reconstructive SurgeryCleveland Clinic FoundationClevelandUSA
  2. 2.Department of Anatomic PathologyCleveland Clinic FoundationClevelandUSA
  3. 3.University of Toledo Medical SchoolToledoUSA

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