Failure of Radiotracer Migration: Salvaging Sentinel Lymph Node Biopsy in Melanoma Care With Indocyanine Green

Abstract

Reducing false negative rates for sentinel lymph node biopsies (SLNB) in melanoma is important to accurately prognosticate and to guide treatment. Traditionally, SLNB has been performed with the adjunct of radiotracers and blue dye. Although sentinel node mapping is highly successful in axillary and inguinal node basins, identification of nodes in the head and neck is not as accurate with traditional methods. One reason for this may be failure of radiotracer migration. To augment standard technique using a radiocolloid, indocyanine green (ICG) combined with near infrared spectroscopy (NIRS), has shown promising results. We demonstrate a case of an individual undergoing SLNB in the head and neck region with failure of radiotracer migration. Identification of a sentinel node was accomplished with the use of ICG and NIRS. This technology offers an opportunity to salvage the SLNB when traditional methods fail.

Current Controversies in Melanoma Treatment

“…51 One method we have found helpful to reduce false-negatives is the use of intraoperative intradermal indocyanine green (ICG) injection at the primary tumor site and SPY imaging of the nodal basins. 52 [See Video 3 (online), which displays sentinel node biopsy assisted by ICG SPY. The ability of ICG SPY to salvage sentinel node retrieval when the nuclear tracer fails to migrate from the primary site to the sentinel node is shown.]…”