Impact of Indocyanine Green Dose on Sentinel Lymph Node Mapping in Cervical Cancer: A Systematic Review

Simple Summary Sentinel lymph node (SLN) mapping is a crucial technique in the surgical treatment of cervical cancer, helping to identify the first lymph nodes that cancer may spread to. Indocyanine green (ICG) is a dye commonly used to make these lymph nodes visible during surgery, but there is no agreement on the best amount to use. This research reviews different amounts of ICG used in previous studies to determine the most effective dose for detecting these lymph nodes. By identifying the best practices, this study aims to improve the accuracy and safety of surgeries for cervical cancer patients. The findings could help standardize the use of ICG in clinical practice, leading to better outcomes for patients and providing clearer guidelines for surgeons.Abstract Over the past decade, SLN mapping has become increasingly important in cervical cancer surgery. ICG is the most commonly used tracer due to its high bilateral detection rates, ease of use, and safety. However, there is no consensus on the optimal ICG dose, leading to variability in outcomes. This systematic review aims to evaluate the impact of different ICG doses on SLN detection in early-stage cervical cancer, identifying the most effective and safe dose for clinical practice. A comprehensive search was conducted in MEDLINE/PubMed up to May 2024. Studies included assessed SLN mapping using ICG in stage IA2-IIA/IIB cervical cancer. Exclusions were applied to studies not reporting ICG dose or using multiple tracers without dose-specific results. Twelve studies were included, with ICG concentrations ranging from 0.25 mg/mL to 25 mg/mL and injection volumes from 1 to 10 mL. Overall SLN detection rates ranged from 88% to 100%, while bilateral detection rates varied between 74.1% and 98.5%. The most consistent results were obtained with an ICG concentration of 1.25 mg/mL and a 4 mL injection volume. In conclusion, an ICG concentration of 1.25 mg/mL with a 4 mL injection volume is recommended for effective SLN mapping in cervical cancer, achieving high detection rates with minimal variability. Standardizing this dose in clinical practice is suggested to improve reproducibility and outcomes.