Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA.
Ann Surg Oncol. 2019 Oct;26(11):3550-3560. doi: 10.1245/s10434-019-07617-z. Epub 2019 Jul 16.
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.
本研究旨在分析接受放射性同位素淋巴闪烁显像和吲哚菁绿（ICG）荧光成像联合的前哨淋巴结活检（SLNB）的黑色素瘤患者，比较我们的真正阳性（TP）率，即对 SLNB 进行即时分析的方法，与文献中的方法。
连续纳入 2012 年至 2018 年期间由资深作者（BG）进行 SLNB 联合淋巴闪烁显像和 ICG 荧光成像的连续皮肤黑色素瘤患者。根据三项研究计算了每个 T 分期的平均预期 SLN 阳性率，并与我们的 SLN 阳性率进行比较。
共分析了 574 例连续患者。平均 Breslow 厚度为 1.9 毫米。共采集了 1754 个前哨淋巴结；1497 个通过伽马探针信号和 ICG 识别，241 个仅通过伽马探针信号识别，16 个仅通过 ICG 识别。有 123 例（21.4%）患者至少有一个阳性 SLN；113 例（91.9%）至少有一个阳性淋巴结通过伽马探针信号和 ICG 同时识别，8 例（6.5%）仅通过伽马探针信号识别出阳性淋巴结，2 例（1.6%）仅通过 ICG 识别出阳性淋巴结。总体 SLN 阳性率为 21.4%，T1 为 8%，T2 为 18.5%，T3 为 41.1%，T4 为 52.4%，均高于各期的预测率。
通过报告最大的黑色素瘤 SLNB 联合淋巴闪烁显像和 ICG 患者队列，我们证明了该技术的 SLN 阳性率高于预测值。患者正在接受随访，但鉴于 TP 数据，我们的结果可能会促进使用这种方式来改善分期和治疗选择。
