PDF(Pubmed)
Abstract：
The standard of care approach to identify sentinel lymph nodes (SLNs) in clinically non-metastatic cutaneous melanoma patients is technetium (Tc)-based lymphoscintigraphy. This technique is associated with radiation exposure, a long intervention time, high costs, and limited availability. Indocyanine green (ICG)-based near-infrared fluorescence imaging offers a potential alternative if proven to be of comparable diagnostic accuracy. While several clinical cohorts have compared these modalities, no systematic review exists that provides a quantitative analysis of their results. Hence, a systematic literature review was conducted in December 2023 considering clinical studies comparing the diagnostic accuracy of ICG and Tc for sentinel lymph node biopsy in cutaneous melanoma patients. Three hundred nineteen studies were identified and further screened in accordance with the PRISMA 2020 guidelines, resulting in seven studies being included in the final meta-analysis. Tc identified a significantly higher number of SLNs and metastatic SLNs in prospective studies only. However, in the overall meta-analysis of all included comparative studies, no significant differences were found regarding the identification of metastatic patients or the false negative rate (FNR). ICG may be a non-inferior alternative to Tc for intraoperative guidance in sentinel lymph node biopsy in cutaneous melanoma patients. Future randomized controlled trials are needed, especially regarding the preoperative, transcutaneous identification of the affected lymph node basin.
摘要：
在临床非转移性皮肤黑色素瘤患者中识别前哨淋巴结（SLN）的标准护理方法是基于tech（Tc）的淋巴闪烁显像。这项技术与辐射暴露有关，干预时间长,高成本,和有限的可用性。基于吲哚菁绿（ICG）的近红外荧光成像提供了一种潜在的替代方法，如果证明具有可比的诊断准确性。虽然几个临床队列比较了这些模式，不存在对其结果进行定量分析的系统性综述.因此，2023年12月进行了系统的文献综述,考虑了比较ICG和Tc对皮肤黑色素瘤患者前哨淋巴结活检的诊断准确性的临床研究.根据PRISMA2020指南确定并进一步筛选了三百十九项研究，导致七项研究被纳入最终的荟萃分析。Tc仅在前瞻性研究中发现了明显更多的SLN和转移性SLN。然而,在所有纳入比较研究的整体荟萃分析中，关于转移患者的鉴定或假阴性率（FNR），没有发现显着差异。在皮肤黑色素瘤患者的前哨淋巴结活检中，ICG可能是Tc的非劣质替代方法。需要未来的随机对照试验，特别是关于术前，经皮识别受影响的淋巴结盆地。
