Division of Dermatology, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
J Surg Oncol. 2012 Jul 1;106(1):41-5. doi: 10.1002/jso.23045. Epub 2012 Jan 17.
Although sentinel lymph node (SLN) biopsy using radioisotope (RI) and blue dye (BD) achieved a high detection rate, approximately 5% of melanomas with negative SLNs develop nodal metastasis. We tested a new lymphatic navigation method using indocyanine green fluorescence imaging (ICG-FI) to detect such "occult" SLNs.
Thirty-four skin cancer patients received SLN biopsy with the following three methods: RI (99Tc-tin colloid), BD (2% patent blue), and ICG (0.5% indocyanine green). Lymph nodes detected by any of the three methods were counted as SLNs.
ICG-FI detected more SLNs in 8 out of the 34 cases (24%). The average numbers of SLNs detected by ICG-FI, RI, and BD were 2.18, 1.76, and 1.73, respectively. Interestingly, ICG-FI not only detected more SLNs in one basin (ICG-FI: 1.64, RI: 1.50, and BD: 1.51 SLNs per basin), but also detected additional SLNs in other basins (ICG-FI: 1.32, RI: 1.18, and BD: 1.15 basins per case).
ICG-FI detected SLNs more efficiently than did the conventional methods, and these "occult" SLNs may offer an explanation for some false-negative cases. We recommend using ICG-FI in addition to a conventional method to reduce the risk of overlooking these "occult" SLNs.
虽然放射性同位素（RI）和蓝色染料（BD）联合使用的前哨淋巴结（SLN）活检具有较高的检出率，但约有 5%的 SLN 阴性黑色素瘤会发生淋巴结转移。我们测试了一种新的淋巴导航方法，即使用吲哚菁绿荧光成像（ICG-FI）来检测这些“隐匿”的 SLN。
34 例皮肤癌患者接受了 SLN 活检，使用了以下三种方法：RI（99Tc-锡胶体）、BD（2%专利蓝）和 ICG（0.5%吲哚菁绿）。通过任何三种方法检测到的淋巴结均被视为 SLN。
ICG-FI 在 34 例中的 8 例（24%）中检测到更多的 SLN。ICG-FI、RI 和 BD 检测到的 SLN 平均数量分别为 2.18、1.76 和 1.73。有趣的是，ICG-FI 不仅在一个区域（ICG-FI：1.64，RI：1.50 和 BD：1.51 个 SLN/区域）中检测到更多的 SLN，而且在其他区域（ICG-FI：1.32，RI：1.18 和 BD：1.15 个 SLN/例）中也检测到了额外的 SLN。
ICG-FI 比传统方法更有效地检测 SLN，这些“隐匿”的 SLN 可能解释了一些假阴性病例。我们建议在使用常规方法的基础上增加 ICG-FI，以降低遗漏这些“隐匿”SLN 的风险。
