Funding sources This work was supported in part by NIH grants R01-CA-115296 and R21-CA-130297 and the Dutch Cancer Society grant UL2010-4732. This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine, project MUSIS (grant 03O-202). J.R.v.d.V. is an MD-medical research trainee funded by the Netherlands Organisation for Health Research and Development (grant 92003593).
CLINICAL AND LABORATORY INVESTIGATIONS
Dose optimization for near-infrared fluorescence sentinel lymph node mapping in patients with melanoma
Article first published online: 21 DEC 2012
© 2012 The Authors. BJD © 2012 British Association of Dermatologists
British Journal of Dermatology
Volume 168, Issue 1, pages 93–98, January 2013
How to Cite
van der Vorst, J.R., Schaafsma, B.E., Verbeek, F.P.R., Swijnenburg, R.J., Hutteman, M., Liefers, G.J., van de Velde, C.J.H., Frangioni, J.V. and Vahrmeijer, A.L. (2013), Dose optimization for near-infrared fluorescence sentinel lymph node mapping in patients with melanoma. British Journal of Dermatology, 168: 93–98. doi: 10.1111/bjd.12059
Conflicts of interest FLARE™ technology is owned by Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School. It has been licensed to the FLARE™ Foundation, a non-profit organization focused on promoting the dissemination of medical imaging technology for research and clinical use. J.V.F. is the founder and chairman of the FLARE™ Foundation. The Beth Israel Deaconess Medical Center will receive royalties for sale of FLARE™ Technology. J.V.F. has elected to surrender post-market royalties to which he would otherwise be entitled as inventor, and has elected to donate pre-market proceeds to the FLARE™ Foundation.
The first two authors contributed equally to the study and share first authorship.
- Issue published online: 21 DEC 2012
- Article first published online: 21 DEC 2012
- Accepted manuscript online: 18 OCT 2012 11:37AM EST
- Accepted for publication 14 September 2012
Background Regional lymph node involvement is the most important prognostic factor in cutaneous melanoma. As only 20% of patients with melanoma have occult nodal disease and would benefit from a regional lymphadenectomy, the sentinel lymph node (SLN) biopsy was introduced. Near-infrared (NIR) fluorescence has been hypothesized to improve SLN mapping.
Objectives To assess the potential of intraoperative NIR fluorescence imaging to improve SLN mapping in patients with melanoma and to examine the optimal dose of indocyanine green adsorbed to human serum albumin (ICG:HSA).
Methods Fifteen consecutive patients with cutaneous melanoma underwent the standard SLN procedure using 99mtechnetium-nancolloid and patent blue. In addition, intraoperative NIR fluorescence imaging was performed after injection of 1·6 mL of 600, 800, 1000 or 1200 μmol L−1 of ICG:HSA in four quadrants around the primary excision scar.
Results NIR fluorescence SLN mapping was successful in 93% of patients. In one patient, no SLN could be identified using either conventional methods or NIR fluorescence. A total of 30 SLNs (average 2·0, range 1–7) were detected, 30 radioactive (100%), 27 blue (73%) and 30 NIR fluorescent (100%). With regard to the effect of concentration on signal-to-background ratios a trend (P = 0·066) was found favouring the 600, 800 and 1000 μmol L−1 groups over the 1200 μmol L−1 group.
Conclusion This study demonstrates feasibility and accuracy of SLN mapping using ICG:HSA. Considering safety, cost and pharmacological characteristics, an ICG:HSA concentration of 600 μmol L−1 appears optimal for SLN mapping in cutaneous melanoma, although lower doses need to be assessed.