ICG-guided sentinel lymph node biopsy in melanoma is as effective as blue dye: A retrospective analysis

Sentinel lymph node biopsy (SLNB) is a key procedure in the staging and management of melanoma. Traditionally, it is performed using a dual-mapping technique combining a radioactive isotope (RI) and blue dye (BD). Fluorescence-guided surgery with indocyanine green (ICG) has emerged as an alternative tracer, offering potential advantages in real-time visualization and operative efficiency. This study compares the efficacy of RI + ICG with RI + BD in SLNB for melanoma.

We conducted a retrospective cohort study at a single center, including 311 patients who underwent SLNB for melanoma. Patients were divided into two groups: RI + BD (n = 227, January 2010-August 2022) and RI + ICG (n = 84, August 2022-February 2024). SLN detection rates, positive SLN rates, operative times, and postoperative complications were compared between the two groups.

Both groups were clinically and pathologically comparable. SLN detection rates were 100 % in the RI + BD group and 98.8 % in the RI + ICG group (p = 0.1). The median number of lymph nodes resected was lower in the RI + ICG group as compared to the RI + BD group (p = 0.047). While positive SLN rates were higher in the RI + ICG group (9.5 % vs. 6.2 %), this difference was not statistically significant (p = 0.3). ICG alone could not identify all the positive SLN. Postoperative complications, including seroma, did not differ significantly between groups.

ICG-guided SLNB is comparable to BD-guided SLNB in terms of detection rate and SLN positivity, although it can not be used alone to identify all positive SLNBs. ICG-based fluorescence imaging is a promising technique that may enhance surgical efficiency in melanoma management.