Application of Indocyanine Green in Gynecology: Review of the Literature

Abstract

The present review aims to analyze the current data available on the different applications of indocyanine green (ICG) in gynecology. A semantic review of English-language publications was performed by searching for MeSH terms and keywords in the PubMed and Google Scholar databases. The studies were finally selected by one author according to the aim of this review. ICG is a highly water-soluble tricarbocyanine dye that fluoresces in the NIR spectrum. Approved by the FDA in 1959, it can be administered either IV (usual dose of 5 mg) or locally/submucosally (usual dose of 5-6.25 mg) according to the pathology or indication. It is used most often in the setting of oncology, endometriosis and other gynecological conditions. In oncological applications, ICG is used to identify sentinel lymph nodes (SLN) using near-infrared light in endometrial, cervical and vulvar cancers. The main advantages that it offers include a reduction of surgical time, improved SLN detection rates, and the ability to avoid radioactivity. In cases of endometrial (submucosal or hysteroscopic applications) or cervical (intracervical administration) cancer, ICG can detect SLN at an accuracy of 95% to 98%. For vulvar cancer, the SLN detection rate can reach 100%. In endometriosis, the lack of good evidence hinders the final evaluation of this method in both diagnostic and therapeutic scenarios. An analytical, well-designed, prospective study is currently underway.