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. 2021 Sep;9(18):1456.
doi: 10.21037/atm-21-4366.

Application of an indocyanine green surgical fluorescence imaging system in sentinel lymph node biopsy of acral malignant melanoma

Keyu Jiang  1 , Binlin Luo  1 , Zuoqiong Hou  1 , Chujun Li  1 , Huiming Cai  2 , Jian Tang  1 , Gang Yao  1
Affiliations

Application of an indocyanine green surgical fluorescence imaging system in sentinel lymph node biopsy of acral malignant melanoma

Keyu Jiang et al. Ann Transl Med. 2021 Sep.

Abstract

Background: Regional lymph node status is an independent influencing factor for the prognosis of acral malignant melanoma, and the accuracy of sentinel lymph node biopsy (SLNB) is directly related to the judgment of regional lymph node status. This study aimed to explore the application value of indocyanine green (ICG) surgical fluorescence imaging system in the SLNB of acral malignant melanoma.

Methods: A total of 34 patients with acral malignant melanoma were admitted to the Department of Burn and Plastic Surgery in Jiangsu Provincial People's Hospital from January 2020 to March 2020. Among these patients, 22 required SLNB. ICG and methylene blue (MB) were combined to intraoperatively trace the sentinel lymph nodes (SLNs). The total number of SLNs detected during the operation was counted. We compared the number, detection rate, as well as the detection rate and false negative rate of positive SLNs of SLNs detected by ICG, MB, and ICG combined with MB.

Results: A total of 56 SLNs were detected in the 22 patients, among which 55 were detected by ICG (98%), 41 were detected by MB (71%), and 56 (100%) were detected by ICG combined with MB, and the average number of SLNs were 2.5, 1.64, and 2.55, respectively. A total of nine SLNs were detected, of which nine were detected by ICG (100%), seven by MB (78%), and nine by ICG combined with MB (100%). Patients with negative SLNs had no recurrence at the 6-month follow-up.

Conclusions: Compared with MB, the ICG fluorescent imaging system can improve the detection rate of SLNs in patients with acral malignant melanoma. Also, ICG combined with MB was superior to ICG alone.

Keywords: Acral malignant melanoma; indocyanine green (ICG); methylene blue (MB); sentinel lymph node biopsy (SLNB).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/atm-21-4366). Dr. HC is an employee of the Nanjing Nuoyuan Medical Devices Co., Ltd., and provided the equipment of the ICG Surgical Fluorescent Imaging System. But the author promises that the paper was not affected during the writing process. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Intraoperative ICG fluorescence imaging of a patient with lower extremity malignant melanoma. ICG, indocyanine green; SLN, sentinel lymph node.
Figure 2
Figure 2
Representative SLN detecting images of ICG, MB. The red arrow marks the lymphatic vessels and lymph nodes that are traced. ICG, indocyanine green; MB, methylene blue; SLN, sentinel lymph node.
See this image and copyright information in PMC

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