ICG Fluorescence with Lymphoscintigraphy for Sentinel Node Biopsy in Head and Neck Cutaneous Melanoma: A Reproducible, Reliable Means to Improve False Negative Rates
Rebecca Knackstedt, MD/PhD, Rafael Couto, MD, Brian Gastman, MD.
Cleveland Clinic Foundation, Cleveland, OH, USA.
Head and neck melanoma is associated with a high false negative sentinel lymph node biopsy (SLNB) rate. Our group previously demonstrated the combination of radiotracer and ICG SPY Elite navigation system was feasible and more sensitive compared to standard vital dye and radioactive tracer for SLNB. The goal of this report was to analyze our experiences utilizing ICG fluorescence with lymphoscintigraphy for SLNB in head and neck cutaneous melanoma.
Data was collected for consecutive head and neck cutaneous melanoma patients who underwent radioisotope lymphocintigraphy and indocyanine green SPY-Elite SNLB by the senior author from 2012-2015. False negative rate of SLNB was defined as the proportion of patients with false negative SLNB (regional nodal recurrence with negative initial SLNB) to patients with true positive and false negative SLNB, as well as the false negative incidence, defined as the proportion of patients with false negative SLNB to all patients.
There were 68 eligible patients, eleven positive SNLB, 55 true negative SLNB and two false negative SLNB. FNR and FNI were 15.3% and 3%, respectively. Mean follow up for true negative patients was 746 days.
The importance of accurate SLNB in head and neck melanoma cannot be underscored. False negative rates in the literature for head and neck melanoma patients are reported as high as 44%. Our results demonstrate that concomitant radioactive and fluorescence for SLN identification in head and neck melanoma is reliable, reproducible and has produced a low false negative SLNB rate.
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