Efficacy of indocyanine green fluoroscopy for sentinel node biopsy in head and neck melanoma: a systematic review and meta-analysis

The objective of this review was to conduct a systematic review and meta-analysis on the efficacy of ICG (indocyanine green) for sentinel lymph node (SLN) detection in head and neck melanoma. The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement standards (PRISMA) were followed when conducting this review with a comprehensive search of the following online databases; Google Scholar, PubMed, MEDLINE, CINAHL, and CENTRAL, World Health Organization International Clinical Trials Registry (http://apps.who.int/trialsearch/), ClinicalTrials.gov (http://clinical-trials.gov/), and the ISRCTN registry (http://www.isrctn.com/). Nine studies met the inclusion criteria and results were reported with forest plots at 95% confidence intervals. Primary outcomes of interest included the localisation rate for sentinel node biopsies in head and neck melanoma using ICG and compared with other adjunct modalities. Secondary outcome measures included false negative rates as well as sensitivity rates for nodal detection with radiocolloid as well as blue dye. ICG reported an overall sensitivity rate of 95% with an untransformed proportion metric analysis (0.950, 0.922, 0.978 (95% CI)). It demonstrated a superior detection rate to blue dye (Odds ratio 15.417, 95% CI, 4.652 to 51.091, p < 0.001) and a comparable localisation efficacy to radiocolloid (Odds ratio 1.425, 95% CI, 0.535 to 3.794, p = 0.478). The sensitivity rate for radiocolloid utilisation in isolation was 90.6% (untransformed proportion metric, 0.906, 0.855, 0.957) and blue dye was 48.7% (untransformed proportion metric, 0.487, 0.364, 0.610). This is the first meta-analysis on the efficacy of ICG for sentinel node detection in head and neck melanoma. The authors advocate for a dual modality approach with ICG and radiocolloid to mitigate the inherent limitations of both methods when conducting sentinel node retrieval for head and neck melanoma. Further high-quality randomised trials are needed to improve the current evidence base.