Indocyanine Green–Guided Sentinel Lymph Node Biopsy in Melanoma: Assessing Clinical Value in a Cohort Over 1000 Patients

Background: The sentinel lymph node biopsy (SLNB) remains the standard for identifying micrometastasis in melanoma. In this study, we utilized our prospectively maintained database to assess whether adding indocyanine green (ICG) fluorescence imaging to radioisotope lymphoscintigraphy improved sentinel node detection and, consequently, clinical outcomes. Methods: Consecutive patients with cutaneous melanoma who underwent dual technique SLNB by the senior author (B.R.G.) from 2012 to 2022 were enrolled. All patients with a negative SLNB result were subjected to a minimum follow-up period of 12 months. Positive and false-negative rates were calculated, and recurrence-free survival (RFS) was used as a measure of clinical outcomes. Results: A total of 1267 patients were identified. The average age was 62 years, with 526 females (41.6%). The mean Breslow depth was 1.82 mm (range 0.2–24 mm). Among 3403 SLNs sampled, 358 were positive (91.1% identified by both modalities). The false-negative rate was 8.5% (25/293), and the median time to recurrence was 13.7 months (range: 2.8–60.4 months). The 12-month RFS for stages IA-IIC were 99%, 98%, 95%, 97%, and 84%, respectively (p = 0.016). Conclusions: These findings support the use of an ICG-based dual technique in SLNB for melanoma, demonstrating diagnostic precision with excellent patient outcomes.

Duke Scholars

Author Rebecca W Knackstedt Surgery, Plastic, Maxillofacial, and Oral Surgery