Indocyanine green and fluorescence lymphangiography for sentinel node identification in patients with melanoma

Background: Infrared fluorescence imaging with indocyanine green (ICG) is a novel method for sentinel node localization. Our objective was to assess ICG and fluorescence imaging for preoperative and intraoperative utility. Methods: 87 eligible patients participated in this prospective study. All patients received injection of ICG dye in addition to both methylene blue and ^99mTc. Each sentinel node was assessed for the presence of each dye. Results: ICG was visible prior to incision in 44% of subjects. ^99mTc identified a mean of 1.89 SLN per patient. ICG identified a mean of 1.87 SLN while methylene blue (MB) dye identified a mean of 0.71 SLN. ^99mTc and ICG identified the same number of sentinel nodes per patient (P =.73) while methylene blue was inferior in its ability to localize sentinel nodes (P <.001). Conclusion: Our findings indicate that ICG/fluorescence imaging has limited ability to identify the nodal basin preoperatively, but is equivalent to ^99mTc for intraoperative identification of sentinel nodes and superior to MB.