Effective Low-dose Escalation of Indocyanine Green for Near-infrared Fluorescent Sentinel Lymph Node Mapping in Melanoma
Effective Low-dose Escalation of Indocyanine Green for Near-infrared Fluorescent Sentinel Lymph Node Mapping in Melanoma
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DOI：
10.1245/s10434-013-2905-x
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发表时间：
2013-07-01
影响因子：
3.7
通讯作者：
Russell, Sara E.
中科院分区：
文献类型：
--
作者：
Gilmore, Denis M.;Khullar, Onkar V.;Russell, Sara E.
区域淋巴结转移是黑色素瘤患者最强的预后因素。已发表的使用放射性胶体和蓝色染料的淋巴结造影术的报告证实，腹股沟淋巴结和腋窝淋巴结的前哨淋巴结（SLN）识别准确，但颈部、腘、肩胛上和肩胛旁淋巴结的准确性降低。近红外成像（NIR）可以利用吲哚菁绿色（ICG）来改进SLN识别。采用近红外光谱技术（NIR）评价白蛋白结合ICG（ICG：HSA）改善黑色素瘤患者SLN定位的安全性、可行性和最佳剂量。术中在原发病灶周围的四个象限注射1.0 ml 100、250或500 μ M ICG：HSA后进行NIR荧光成像，与放射性胶体相比，NIR荧光成像的准确性为98%。共识别出65个淋巴结（65个用Tc-99 m，64个用ICG：HSA）。总体而言，使用任一技术的成功标测率为96%，因为1例患者未能使用任一模式进行标测。随着ICG剂量的增加，在100、250和500 μ M范围内，信号背景比的中位数分别从3.1增加到8.4和10.9。ICG具有成本低和术中技术不改变术野的额外优势，因此易于识别SLN。
Regional lymph node metastasis is the strongest prognostic factor in patients with melanoma. Published reports that used lymphoscintigraphy with radioactive colloids and blue dye demonstrated accurate sentinel lymph node (SLN) identification in inguinal nodes and axillary nodes, but decreased accuracy in cervical, popliteal, epitrochlear, and parascapular nodes. Near-infrared imaging (NIR) may utilize indocyanine green (ICG) to improve SLN identification. The safety, feasibility and optimal dose of albumin-bound ICG (ICG:HSA) was assessed by NIR to improve SLN mapping in patients with melanoma.Twenty-five consecutive patients with biopsy-proven melanoma underwent standard SLN mapping with preoperatively administered technetium-99 m nanocolloid (Tc-99 m). Intraoperative NIR fluorescence imaging was performed after injection of 1.0 ml of 100, 250 or 500 mu M of ICG:HSA in four quadrants around the primary lesion.NIR fluorescent imaging demonstrated accuracy of 98 % when compared with radioactive colloid. A total of 65 lymph nodes were identified (65 with Tc-99 m, 64 with ICG:HSA). Overall, successful mapping that used either technique was 96 % as one patient failed to map with either modality. As the dose of ICG was increased, the signal-to-background ratio increased from a median of 3.1 to 8.4 to 10.9 over the range of 100, 250, and 500 mu M, respectively.SLN mapping with ICG:HSA is feasible and accurate in melanoma. ICG has the added advantage of a low cost and an intraoperative technique that does not alter the surgical field, thus allowing for easy identification of SLNs.