Indocyanine Green SPY Elite-Assisted Sentinel Lymph Node Biopsy in Cutaneous Melanoma
Indocyanine Green SPY Elite-Assisted Sentinel Lymph Node Biopsy in Cutaneous Melanoma
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DOI：
10.1097/prs.0000000000000006
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发表时间：
2014-04-01
影响因子：
3.6
通讯作者：
Gastman, Brian
中科院分区：
文献类型：
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作者：
Korn, Jason M.;Tellez-Diaz, Alejandra;Gastman, Brian
背景：前哨淋巴结活检是中等深度和高风险薄黑色素瘤的标准治疗。最近，吲哚菁绿色和近红外成像已被用来帮助前哨淋巴结活检。本研究的目的是确定的可行性，前哨淋巴结活检与吲哚菁绿色SPY精英导航和严格评估技术相比，与标准models.Methods：90个连续的皮肤黑色素瘤患者进行前哨淋巴结活检的回顾性分析。形成两个队列：A组，使用蓝色染料和放射性同位素进行前哨淋巴结活检; B组，使用放射性同位素和吲哚菁绿色SPY Elite导航进行前哨淋巴结活检。队列进行了比较，以评估差异的定位率，敏感性和特异性的前哨淋巴结的识别，和lengths.Results：前哨淋巴结定位率为79.4%，使用蓝色染料法，98.0%，使用吲哚菁绿色荧光法，97.8%，使用放射性同位素/手持伽玛探针法。吲哚菁绿色荧光比单独的活体染料方法检测到更多的前哨淋巴结（p = 0.020）。在SPY Elite队列中观察到手术时间缩短的趋势。结论：使用吲哚菁绿色SPY Elite导航系统在皮肤黑色素瘤中进行前哨淋巴结标测和定位在技术上是可行的，并且可能提供优于当前模式的几个优势，包括更高的灵敏度和特异性、更少的淋巴结采样数量、更短的手术时间，和潜在的较低的假阴性率。临床问题/证据等级：诊断，II。
Background: Sentinel lymph node biopsy is the standard of care for intermediate-depth and high-risk thin melanomas. Recently, indocyanine green and near-infrared imaging have been used to aid in sentinel node biopsy. The present study aimed to determine the feasibility of sentinel lymph node biopsy with indocyanine green SPY Elite navigation and to critically evaluate the technique compared with the standard modalities.Methods: A retrospective review of 90 consecutive cutaneous melanoma patients who underwent sentinel lymph node biopsy was performed. Two cohorts were formed: group A, which had sentinel lymph node biopsy performed with blue dye and radioisotope; and group B, which had sentinel lymph node biopsy performed with radioisotope and indocyanine green SPY Elite navigation. The cohorts were compared to assess for differences in localization rates, sensitivity and specificity of sentinel node identification, and length of surgery.Results: The sentinel lymph node localization rate was 79.4 percent using the blue dye method, 98.0 percent using the indocyanine green fluorescence method, and 97.8 percent using the radioisotope/handheld gamma probe method. Indocyanine green fluorescence detected more sentinel lymph nodes than the vital dye method alone (p = 0.020). A trend toward a reduction in length of surgery was noted in the SPY Elite cohort.Conclusions: Sentinel lymph node mapping and localization in cutaneous melanoma with the indocyanine green SPY Elite navigation system is technically feasible and may offer several advantages over current modalities, including higher sensitivity and specificity, decreased number of lymph nodes sampled, decreased operative time, and potentially lower false-negative rates.CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.