Document Detail


Dose optimization for near-infrared fluorescence sentinel lymph node mapping in patients with melanoma.
MedLine Citation:
PMID:  23078649     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 (99m) technetium-nancolloid and patent blue. In addition, intraoperative NIR fluorescence imaging was performed after injection of 1·6 mL of 600, 800, 1000 or 1200 μmolL(-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 μmolL(-1) appears optimal for SLN mapping in cutaneous melanoma, although lower doses need to be assessed.
Authors:
J R van der Vorst; B E Schaafsma; F P R Verbeek; R J Swijnenburg; M Hutteman; G J Liefers; C J H van de Velde; J V Frangioni; A L Vahrmeijer
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The British journal of dermatology     Volume:  168     ISSN:  1365-2133     ISO Abbreviation:  Br. J. Dermatol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-02     Completed Date:  2013-06-07     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  England    
Other Details:
Languages:  eng     Pagination:  93-8     Citation Subset:  IM    
Copyright Information:
© 2012 The Authors. BJD © 2012 British Association of Dermatologists.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Coloring Agents / diagnostic use
Dose-Response Relationship, Radiation
Feasibility Studies
Female
Fluorescence
Humans
Indocyanine Green / diagnostic use
Intraoperative Care / methods
Lymph Node Excision / methods
Lymph Nodes / pathology*
Lymphatic Metastasis
Male
Melanoma / pathology*,  surgery
Middle Aged
Sentinel Lymph Node Biopsy / methods
Serum Albumin / radiation effects
Skin Neoplasms / pathology*,  surgery
Spectroscopy, Near-Infrared / methods
Young Adult
Grant Support
ID/Acronym/Agency:
R01 CA115296/CA/NCI NIH HHS; R01-CA-115296/CA/NCI NIH HHS; R21 CA130297/CA/NCI NIH HHS; R21-CA-130297/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/Coloring Agents; 0/Serum Albumin; IX6J1063HV/Indocyanine Green
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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