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Updated: May 12, 2026
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Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology
Published on: October 20, 2010
Sentinel lymph node detection in melanoma: indocyanine green fluorescence compared with conventional mapping
Yu Zhang1, Sahar Borna2, Rajendra Saw-Martinez1,2
1University of Central Florida College of Medicine.
Melanoma Research
|May 10, 2026
Summary
Near-infrared fluorescence with indocyanine green (ICG) provides effective sentinel lymph node (SLN) mapping for melanoma staging, comparable to technetium-99m (Tc-99m) and superior to blue dye alone.
Area of Science:
- Oncology
- Surgical Innovation
- Medical Imaging
Background:
- Accurate sentinel lymph node (SLN) mapping is critical for melanoma staging and treatment decisions.
- Conventional SLN mapping relies on technetium-99m (Tc-99m) radiocolloid and/or blue dye.
- Near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) offers radiation-free visualization but has variable transcutaneous performance.
Purpose of the Study:
- To review and synthesize current evidence comparing ICG with Tc-99m and blue dye for SLN detection in melanoma.
- To highlight anatomic, technical, and safety factors influencing surgical workflow.
- To assess the utility of ICG, particularly in head/neck melanoma and dual-tracer strategies.
Main Methods:
- Narrative review of prospective studies, head-to-head comparisons, and systematic reviews/meta-analyses.
- Evaluation of SLN identification rates, node-level detection, and fluorescence performance (transcutaneous vs. intraoperative).
- Analysis of false-negative rates, adverse events, and specific considerations for head/neck melanoma.
Main Results:
- ICG achieves high patient-level SLN identification rates (79-100%), comparable to Tc-99m (86-100%) and superior to blue dye alone.
- Dual-tracer methods (ICG + Tc-99m or ICG + blue dye) demonstrate near-universal detection and reduced missed nodes.
- Intraoperative ICG fluorescence is highly reliable and expedites dissection; transcutaneous performance is limited by tissue penetration and BMI.
- Head/neck basins benefit significantly from ICG's real-time visualization of complex lymphatic channels.
Conclusions:
- ICG fluorescence is a valuable adjunct for SLN mapping in melanoma, offering real-time intraoperative guidance.
- Dual-tracer approaches enhance detection rates, complementing standard radiocolloid mapping.
- ICG offers an excellent safety profile, avoids radiation, and integrates well with existing gamma-probe technology.