Journal: Annals of surgical oncology
Study type
Retrospective single-center cohort (2012–2024) of 375 consecutive patients with cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB).
Intervention and comparison
- All patients had technetium-99m radioisotope (RI) mapping.
- Adjunct tracer was either:
- Indocyanine green (ICG) fluorescence + RI (n=170), or
- Isosulfan blue (IB) + RI (n=215).
Endpoints
- Primary: Intraoperative concordance of the dye (ICG or IB) with RI for SLN detection at patient and node levels.
- Secondary: Detection of pathology-positive nodes, tracer discordance, adverse events, and AI-assisted identification of dye-positive/RI-negative (“dye-rescued”) SLNs.
Key results
- Cohort: 375 patients (median age 62; 54.7% male); 890 SLNs excised.
- Concordance with RI (ICG vs IB):
- Per patient: 98.6% vs 34.8%
- Per node: 97.7% vs 34.9% (p<0.001 for both).
- Discordance: Dye and RI not matching was much lower with ICG (1.4%) than IB (65.2%).
- Pathology-positive nodes: All pathology-positive nodes in the ICG group were localized intraoperatively, versus only 53.4% in the IB group.
- Safety: No tracer-related allergic reactions were observed.
- AI-assisted review: Confirmed 9 ICG and 1 IB cases in which dye-positive/RI-negative nodes were “rescued” by the dye.
Clinical interpretation
ICG fluorescence, used with RI, showed markedly higher concordance than IB with RI and more reliable intraoperative detection of pathology-positive SLNs, without added safety concerns. These data support ICG as a superior adjunct tracer to IB for melanoma SLNB in this setting.