Plastic Surgery Research Council
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Presenter: Jason M Korn, MD
Co-Authors: Bartz-Kurycki MA; Gastman BR
Cleveland Clinic Foundation

Background: Nodal status, utilizing sentinel lymph node biopsy (SLNB), is the most important prognostic indicator in localized cutaneous melanoma. Preoperative lymphoscintigraphy with Tc-99m labeled sulfur colloid and intra-operative hand-held gamma-probe guidance and/or intraoperative injection of dye (methylene blue or 1% lymphazurin) are currently utilized for SLNB, but have a false negative rate of 13% (0-34%). Recent studies indicate that the addition of indocyanine green (ICG) to SLNB may help detect occult sentinel nodes and reduce false negatives. The SPY-Elite system (LifeCell Corp. Branchburg, NJ), initially developed to evaluate tissue perfusion utilizing ICG, has been used concurrently with Tc-99m labeled sulfur colloid at our institution in an effort to identify occult sentinel lymph nodes.

Methods: A review of consecutive melanoma patients treated at Cleveland Clinic Foundation with SLNB performed with guidance of ICG/SPY-elite and Tc-99m from April 2012 through September 2012 was performed. Data collected included patient age, lesion location, Breslow depth, type of melanoma, number of nodes identified by each modality, and final nodal pathology. Each patient served as their own control. SAS (v9.2) software was used for statistical analysis.

Results: Over a 7 month period, 23 consecutive melanoma patients (5 head and neck, 7 trunk, 6 upper extremity, and 5 lower extremity) were treated with SLNB using both modalities. Sentinel lymph nodes were identified in 23 of 23 patients (100%) utilizing the ICG-SPY and 22 of 23 (96%) utilizing the Tc-99m labeled sulfur colloid and gamma probe. Three patients had positive SLNs that were identified with both modalities and, subsequently, had completion dissections. To date no local or regional recurrences have been detected.

Conclusions: Intra-operative ICG and SPY-elite guidance is effective at identifying sentinel lymph nodes in localized cutaneous melanoma and may offer increased sensitivity in node identification for SLNB. This increased sensitivity could hypothetically correlate with a lower false negative SLNB rate though long-term follow-up is necessary.

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