Wölffer Marcus, Liechti Rémy, Constantinescu Mihai, Lese Ioana, Zubler Cédric
Department of Orthopaedics, Hand and Trauma Surgery, Stadtspital Waid, Tièchestrasse 99, 8037 Zürich, Switzerland.
Department of Plastic and Hand Surgery, University of Bern, Inselspital University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
Cancers (Basel). 2024 Jul 12;16(14):2523. doi: 10.3390/cancers16142523.
The standard of care approach to identify sentinel lymph nodes (SLNs) in clinically non-metastatic cutaneous melanoma patients is technetium (Tc)-based lymphoscintigraphy. This technique is associated with radiation exposure, a long intervention time, high costs, and limited availability. Indocyanine green (ICG)-based near-infrared fluorescence imaging offers a potential alternative if proven to be of comparable diagnostic accuracy. While several clinical cohorts have compared these modalities, no systematic review exists that provides a quantitative analysis of their results. Hence, a systematic literature review was conducted in December 2023 considering clinical studies comparing the diagnostic accuracy of ICG and Tc for sentinel lymph node biopsy in cutaneous melanoma patients. Three hundred nineteen studies were identified and further screened in accordance with the PRISMA 2020 guidelines, resulting in seven studies being included in the final meta-analysis. Tc identified a significantly higher number of SLNs and metastatic SLNs in prospective studies only. However, in the overall meta-analysis of all included comparative studies, no significant differences were found regarding the identification of metastatic patients or the false negative rate (FNR). ICG may be a non-inferior alternative to Tc for intraoperative guidance in sentinel lymph node biopsy in cutaneous melanoma patients. Future randomized controlled trials are needed, especially regarding the preoperative, transcutaneous identification of the affected lymph node basin.
在临床无转移的皮肤黑色素瘤患者中，识别前哨淋巴结（SLN）的标准治疗方法是基于锝（Tc）的淋巴闪烁显像术。该技术存在辐射暴露、干预时间长、成本高以及可用性有限等问题。如果基于吲哚菁绿（ICG）的近红外荧光成像被证明具有可比的诊断准确性，那么它将提供一种潜在的替代方法。虽然有几个临床队列对这些方法进行了比较，但尚无系统评价对其结果进行定量分析。因此，2023年12月进行了一项系统文献综述，纳入了比较ICG和Tc在皮肤黑色素瘤患者前哨淋巴结活检中诊断准确性的临床研究。共识别出319项研究，并根据PRISMA 2020指南进行进一步筛选，最终有7项研究纳入荟萃分析。仅在前瞻性研究中，Tc识别出的SLN和转移SLN数量显著更多。然而，在所有纳入的比较研究的总体荟萃分析中，在转移患者的识别或假阴性率（FNR）方面未发现显著差异。对于皮肤黑色素瘤患者前哨淋巴结活检的术中引导，ICG可能是Tc的非劣效替代方法。未来需要进行随机对照试验，特别是关于术前经皮识别受累淋巴结区域的试验。
