{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:11:34Z","timestamp":1784304694867,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sentinel lymph node biopsy (SLNB) is commonly used for axillary staging in breast cancer surgery. Traditional localization methods include technetium\u201099m, lymphazurin, methylene blue (MB), or a combination of these. Indocyanine green (ICG) is a safe and effective alternative with fewer complications. We compared the cost\u2010effectiveness of ICG and MB for SLNB in breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic PubMed review identified the success and complication rates for MB and ICG. Costs of successful breast cancer surgeries with SLNB and related complications were estimated using Centers for Medicare &amp; Medicaid Services (CMS) rates via Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) codes. Published utility scores were used to calculate quality\u2010adjusted life years (QALYs). A decision tree model was developed to determine the incremental cost\u2010effectiveness ratio (ICER). One\u2010way (deterministic) and Monte Carlo (probabilistic) sensitivity analyses were performed to assess uncertainty. The willingness\u2010to\u2010pay (WTP) threshold was set to $50,000\/QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SLNB using ICG cost $287 more than MB but gained 0.07 QALY, resulting in an ICER of $4,044.44, well below the WTP threshold. Sensitivity analysis showed SLNB with ICG became cost\u2010ineffective if the probability of complication exceeded 4.9% or if ICG costs exceeded $4,190 per vial. SLNB with MB became cost\u2010effective if the likelihood of complications dropped below 2.6%. Monte Carlo analysis indicated an 80% probability that SLNB with ICG is the more cost\u2010effective option.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Given lower complication rates despite higher upfront cost, ICG proved more cost\u2010effective than MB in SLNB for breast cancer due to its improved quality\u2010adjusted outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70278","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T06:54:21Z","timestamp":1778482461000},"page":"41-53","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost\u2010Utility Analysis of Indocyanine Green Versus Methylene Blue for Sentinel Lymph Node Biopsy in Breast Cancer"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1768-8676","authenticated-orcid":false,"given":"Sonia H.","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Surgery Tufts Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ainsley","family":"Kohler","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Tingen","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline A.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Surgery Tufts Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah M.","family":"Persing","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology Tufts Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Homsy","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery Tufts Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Nardello","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology Tufts Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology Tufts Medical Center Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.08.001"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PPO.0000000000000090"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2015.08.311"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.5999\/aps.2014.41.3.258"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2020.07.012"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09288-7"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs5.50157"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2015.12.007"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-016-1064-z"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2020.21.5.1187"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.3892\/ol.2020.12375"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2023.10.021"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9610(02)00945-5"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2007.08.060"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4741.2007.00519.x"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.3233\/BD-140371"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2020.03.013"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clbc.2023.02.002"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000025365"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-023-13824-6"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.4103\/jcrt.JCRT_772_19"},{"issue":"220","key":"e_1_2_10_23_1","first-page":"75818","article-title":"Medicare and Medicaid Programs; 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