{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T20:22:55Z","timestamp":1770063775837,"version":"3.49.0"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Sentinel lymph node (SLN) biopsy has emerged as a cornerstone in melanoma staging, offering targeted evaluation of regional lymphatic spread and guiding therapeutic decision-making. Traditionally, SLN mapping relies on lymphoscintigraphy using technetium-99m (Tc-99m) radiocolloid, but in recent years, indocyanine green (ICG) fluorescence imaging has emerged as a promising alternative. The aim of this review is to evaluate the diagnostic accuracy of ICG\u2013near-infrared (NIR) imaging compared to standard Tc-99m lymphoscintigraphy in SLN biopsy (SLNB). Methods: A systematic review and meta-analysis were conducted, including 12 studies. The primary outcome was the false-negative rate; secondary outcomes included the total number of sentinel lymph nodes (SLNs) identified by ICG\u2013NIR imaging and Tc-99m lymphoscintigraphy, the number of metastatic SLNs detected by each method, and the number of patients with metastatic disease. The statistical analysis for dichotomous variables was performed using the \u201cOdds Ratio\u201d (O.R.) calculated with the Mantel\u2013Haenszel method. For continuous variables, the analysis utilized the \u201cMean Difference\u201d calculated by the inverse variance method. All data are presented with a 95% confidence interval (CI). Results: ICG was associated with a significantly higher number of SLNs identified compared to Tc-99m (O.R.: 0.41, 95% CI: 0.34\u20130.49; p &lt; 0.00001), while no significant differences were found in the detection of metastatic nodes, either as a proportion of total SLNs (O.R.: 1.04, 95% CI: 0.86\u20131.25; p = 0.68) or relative to total positive nodes (O.R.: 0.36, 95% CI: 0.16\u20130.81; p = 0.01). No statistically significant differences between the two techniques were found in the detection of metastatic patients (OR: 0.80, 95% CI: 0.31\u20132.03, p = 0.33) and in the total number of false-negative patients missed (risk difference (RD): 0.03, 95% CI: \u22120.04 to 0.09, p = 0.93). Conclusions: While ICG identifies a higher number of SLNs compared to Tc-99m, its ability to detect metastatic involvement is comparable between the two modalities. No significant differences were observed in the proportion of metastatic SLNs, the total number of positive nodes detected, the number of metastatic patients identified, and the false-negative rate. Given its favorable profile, ICG could represent a reliable alternative or adjunct to Tc-99 in SLNB. However, prospective studies are warranted to validate its standalone diagnostic role.<\/jats:p>","DOI":"10.3390\/jcm15031145","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T09:00:33Z","timestamp":1770022833000},"page":"1145","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Indocyanine Green (ICG) Fluorescence vs. Tc-99m Lymphoscintigraphy: Optimizing Sentinel Lymph Node Detection in Cutaneous Melanoma\u2014A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Matteo","family":"Matteucci","sequence":"first","affiliation":[{"name":"Department of Medicine and General Surgery, University of Milan, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7560-551X","authenticated-orcid":false,"given":"Antonio","family":"Pesce","sequence":"additional","affiliation":[{"name":"Department of Surgery, Azienda Unit\u00e0 Sanitaria Locale (AUSL) Ferrara, 44121 Ferrara, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1889-2644","authenticated-orcid":false,"given":"Bruno","family":"Cirillo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sapienza University, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1985-0091","authenticated-orcid":false,"given":"Lorenza","family":"Zampino","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale G. Fornaroli, ASST Ovest Milanese, 20013 Magenta, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Masserano","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ospedale San Paolo, ASST Santi Paolo e Carlo, 20142 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7668-3042","authenticated-orcid":false,"given":"Salvatore","family":"Guarino","sequence":"additional","affiliation":[{"name":"Department of General Surgery, IRCCS Multimedica Sesto San Giovanni, 20099 Sesto San Giovanni, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5309-2386","authenticated-orcid":false,"given":"Luca","family":"Properzi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5709-2530","authenticated-orcid":false,"given":"Vito","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sapienza University, 00161 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2457-0636","authenticated-orcid":false,"given":"Roberto","family":"Cirocchi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Cirocchi, R., Cicoletti, M., Arcangeli, F., Tebala, G.D., Bruzzone, P., Avenia, S., Poli, G., Trastulli, S., and Matteucci, M. (2023). Preliminary Study of Axillary Lymphatic Drainage in Cutaneous Melanoma Patients: A Cross-Sectional Study. Medicina, 59.","DOI":"10.3390\/medicina59081357"},{"key":"ref_3","first-page":"472","article-title":"Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual","volume":"67","author":"Gershenwald","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3417","DOI":"10.1007\/s00268-020-05631-x","article-title":"Low-cost Fluorescein as an Alternative to Radio-colloid for Sentinel Lymph Node Biopsy-a Prospective Validation Study in Early Breast Cancer","volume":"44","author":"Valiveru","year":"2020","journal-title":"World J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1097\/SLA.0000000000005633","article-title":"Sentinel Lymph Node Mapping in Breast Cancer Patients through Fluorescent Imaging Using Indocyanine Green: The INFLUENCE Trial","volume":"276","author":"Bargon","year":"2022","journal-title":"Ann. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3014","DOI":"10.1245\/s10434-021-11255-9","article-title":"A Prospective Study Evaluating the Accuracy of Indocyanine Green (ICG) Fluorescence Compared with Radioisotope for Sentinel Lymph Node (SLN) Detection in Early Breast Cancer","volume":"29","author":"Dumitru","year":"2022","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"114","DOI":"10.3892\/ol.2020.12375","article-title":"Comparisons of ICG-fluorescence with conventional tracers in sentinel lymph node biopsy for patients with early-stage breast cancer: A meta-analysis","volume":"21","author":"Yin","year":"2021","journal-title":"Oncol. Lett."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"W\u00f6lffer, M., Liechti, R., Constantinescu, M., Lese, I., and Zubler, C. (2024). Sentinel Lymph Node Detection in Cutaneous Melanoma Using Indocyanine Green-Based Near-Infrared Fluorescence Imaging: A Systematic Review and Meta-Analysis. Cancers, 16.","DOI":"10.3390\/cancers16142523"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1245\/s10434-022-12978-z","article-title":"Sentinel Lymph Node Procedure in Pediatric Patients with Melanoma, Squamous Cell Carcinoma, or Sarcoma Using Near-Infrared Fluorescence Imaging with Indocyanine Green: A Feasibility Trial","volume":"30","author":"Jeremiasse","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.bjoms.2024.04.012","article-title":"Efficacy of indocyanine green fluoroscopy for sentinel node biopsy in head and neck melanoma: A systematic review and meta-analysis","volume":"62","author":"Hotchkies","year":"2024","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1001\/jama.283.15.2008","article-title":"Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.2196\/jmir.2021","article-title":"Sensitivity and predictive value of 15 PubMed search strategies to answer clinical questions rated against full systematic reviews","volume":"14","author":"Agoritsas","year":"2012","journal-title":"J. Med. Internet Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4333","DOI":"10.1245\/s10434-023-13405-7","article-title":"The Use of Indocyanine Green and Near-Infrared Fluorescence Imaging versus Blue Dye in Sentinel Lymph Node Biopsy in Cutaneous Melanoma: A Retrospective, Cohort Study","volume":"30","author":"Fadel","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jss.2018.02.064","article-title":"Indocyanine green fluorescence imaging with lymphoscintigraphy for sentinel node biopsy in head and neck melanoma","volume":"228","author":"Knackstedt","year":"2018","journal-title":"J. Surg. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"83e","DOI":"10.1097\/PRS.0000000000008096","article-title":"Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy Improves the Accuracy of Sentinel Lymph Node Biopsy in Melanoma","volume":"148","author":"Knackstedt","year":"2021","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/08998280.2022.2147385","article-title":"Use of indocyanine green for sentinel lymph node biopsy in melanoma","volume":"36","author":"Kwizera","year":"2023","journal-title":"Proc. Bayl. Univ. Med. Cent."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1002\/hed.27563","article-title":"Sentinel lymph node biopsy for head and neck malignancies utilizing simultaneous radioisotope gamma probe and indocyanine green fluorescence navigation","volume":"46","author":"Sethi","year":"2024","journal-title":"Head Neck"},{"key":"ref_19","first-page":"51","article-title":"Indocyanine green fluorescence-guided sentinel lymph node biopsy in dermato-oncology","volume":"10","author":"Stoffels","year":"2012","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1001\/jamasurg.2014.3502","article-title":"Intraoperative Fluorescence Imaging for Sentinel Lymph Node Detection: Prospective Clinical Trial to Compare the Usefulness of Indocyanine Green vs Technetium Tc 99m for Identification of Sentinel Lymph Nodes","volume":"150","author":"Stoffels","year":"2015","journal-title":"JAMA Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/SAP.0000000000004348","article-title":"A Comparative Analysis of Sentinel Lymph Node Sampling Utilizing Sentinel Lymphoscintigraphy Alone Versus the Combined Application of Sentinel Lymphoscintigraphy and Fluorescence Lymphangiography","volume":"95","author":"Duran","year":"2025","journal-title":"Ann. Plast. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102167","DOI":"10.1016\/j.suronc.2024.102167","article-title":"ICG-guided sentinel lymph node biopsy in melanoma is as effective as blue dye: A retrospective analysis","volume":"57","author":"Lavy","year":"2024","journal-title":"Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1097\/CMR.0000000000000994","article-title":"Transcutaneous sentinel lymph node detection in skin melanoma with near-infrared fluorescence imaging using indocyanine green","volume":"34","author":"Zweedijk","year":"2024","journal-title":"Melanoma Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s13550-017-0312-1","article-title":"Introducing navigation during melanoma-related sentinel lymph node procedures in the head-and-neck region","volume":"7","author":"KleinJan","year":"2017","journal-title":"EJNMMI Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1097\/PRS.0000000000000006","article-title":"Indocyanine green SPY elite-assisted sentinel lymph node biopsy in cutaneous melanoma","volume":"133","author":"Korn","year":"2014","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1016\/j.ejso.2022.01.021","article-title":"Sentinel lymph node melanoma metastases: Assessment of tumor burden for clinical prediction of outcome in the first Multicenter Selective Lymphadenectomy Trial (MSLT-I)","volume":"48","author":"Cochran","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e30424","DOI":"10.1097\/MD.0000000000030424","article-title":"Transcutaneous sentinel lymph node detection in cutaneous melanoma with indocyanine green and near-infrared fluorescence: A diagnostic sensitivity study","volume":"101","author":"Lese","year":"2022","journal-title":"Medicine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2357","DOI":"10.1245\/s10434-013-2905-x","article-title":"Effective low-dose escalation of indocyanine green for near-infrared fluorescent sentinel lymph node mapping in melanoma","volume":"20","author":"Gilmore","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e199020","DOI":"10.1001\/jamanetworkopen.2019.9020","article-title":"Assessment of Nonradioactive Multispectral Optoacoustic Tomographic Imaging With Conventional Lymphoscintigraphic Imaging for Sentinel Lymph Node Biopsy in Melanoma","volume":"2","author":"Stoffels","year":"2019","journal-title":"JAMA Netw. 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