American Association of Plastic Surgeons

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Determining the False Negative Rate Using Indocyanine Green Guided Sentinel Lymph Node Biopsy in Cutaneous Melanoma; Experience with over 400 Patients
Rebecca Knackstedt, MD PhD, Rafael Couto, MD, Daisy Wu, MD, Brian Gastman, MD.
Cleveland Clinic, Cleveland, OH, USA.

Purpose Surgical management for cutaneous melanoma involves surgical excision with or without a sentinel lymph node biopsy (SNLB). A false negative sentinel node can result in inappropriate work-up and treatment. Our group previously demonstrated lymphoscintography and indocyanine green (ICG) technology was feasible for sentinel lymph node biopsy in melanoma. Methods Consecutive cutaneous melanoma patients who underwent radioisotope lymphocintigraphy and ICG-based fluorescence imaging by the senior author from 2012-2017 were prospectively enrolled . Charts were reviewed for patient and melanoma characteristics, operative technique and findings, pathological data and outcomes. A predicted true positive rate was determined based on previously conducted multi-institutional trials Results 405 consecutive patients were analyzed. 324 (80%) patients had a negative SNLB and 81 (20%) had a positive SLNB. Eight patients with a negative SLNB recurred in the nodal basin. Two experienced local recurrence and three in-transit metastasis in conjunction with nodal recurrence. 316 (78%) patients had true negative SLNB, 81 (20%) patients had true positive SLNB and 8 (2%) patients had a false negative SLNB. This resulted in a FNR of 9%. Our true positive rate of 20.3% was higher than the predicted 11.3% and was upheld for each T-stage. Meanfollow-up was 33.4 months. Conclusions This is the largest cohort of patients reported with cutaneous melanoma who underwent SLNB with lymphoscintography and ICG. Our results demonstrate that this approach is reliable, reproducible and produces a high true positive and a low false negative SLNB rate.


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