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Indocyanine Green

Indocyanine Green (ICG) is a versatile medical dye being studied in various clinical trials for its ability to enhance visualization during surgical procedures and aid in diagnosis. This article explores how ICG is being used to improve outcomes in areas like cancer surgery, lymphedema assessment, and liver function testing.

Table of Contents

What is Indocyanine Green (ICG)?

Indocyanine Green, commonly abbreviated as ICG, is a medical dye used in various diagnostic and surgical procedures. It’s also known by other names such as IC-GREEN, SPY AGENT GREEN, or simply ICG[1][2]. This special dye is safe for use in the human body and has unique properties that make it valuable in medical settings.

How Does ICG Work?

ICG is what’s called a fluorescent dye. When injected into the body, it binds to proteins in the blood. When exposed to a special kind of light called near-infrared light, ICG glows or “fluoresces,” giving off a bright green color. This property allows doctors to visualize blood flow, lymphatic drainage, and other structures in the body that are normally difficult to see[3].

Medical Uses of ICG

ICG has a wide range of applications in medicine, including:

  • Cancer Surgery: ICG helps surgeons identify and remove tumors more accurately. It’s used in various types of cancer surgeries, including:
    • Breast cancer: To map lymph nodes and check for cancer spread[2]
    • Lung cancer: To locate small tumors and guide their removal[3][4]
    • Head and neck cancer: To help surgeons distinguish between cancerous and normal tissue[5]
  • Bariatric Surgery: ICG is used to check blood flow in the stomach and intestines during weight loss surgeries[1]
  • Lymphatic System Imaging: To visualize lymph nodes and lymphatic vessels, which is helpful in diagnosing and treating conditions like lymphedema (swelling due to blocked lymph drainage)[6]
  • Liver Function Tests: ICG can be used to assess how well the liver is working
  • Eye Angiography: To examine blood vessels in the eye

How is ICG Administered?

ICG is typically given in one of two ways:

  1. Intravenous (IV) Injection: The dye is injected into a vein, usually in the arm. This method is used when doctors need to see blood flow in larger areas of the body[1].
  2. Direct Injection: In some cases, ICG is injected directly into the area of interest. For example, in breast cancer surgery, it might be injected near the tumor site or under the skin[6].

After injection, special cameras or imaging devices are used to detect the fluorescence and create images that help guide the medical procedure.

Safety and Side Effects

ICG is generally considered very safe. It has been used in medical procedures for many years. However, like any medical treatment, there are some potential risks and side effects to be aware of:

  • Allergic reactions: These are rare but can occur. Patients with a known allergy to iodine should inform their doctor, as ICG contains iodine[1].
  • Mild side effects: Some patients may experience nausea, itching, or a headache after receiving ICG.

Your healthcare team will monitor you closely during and after the procedure to ensure your safety.

Ongoing Research and Future Applications

Researchers are continually finding new ways to use ICG in medicine. Some areas of ongoing research include:

  • Improving surgical techniques for various types of cancer[7]
  • Enhancing the accuracy of lymph node mapping in different cancers[8]
  • Using ICG to guide nerve decompression surgeries[9]
  • Exploring its use in rheumatoid arthritis to study lymphatic system changes[6]

As research continues, ICG may become even more widely used in various medical fields, potentially leading to improved diagnostic accuracy and surgical outcomes for patients.

Application Description Potential Benefits
Cancer Surgery ICG used to visualize tumors and lymph nodes More precise tumor removal, improved lymph node mapping
Lymphedema Assessment ICG lymphography for real-time lymph flow visualization Quick, radiation-free diagnosis and monitoring
Liver Transplantation ICG clearance tests for liver function assessment Better graft viability assessment, prediction of post-transplant function
Gallbladder Surgery ICG to highlight biliary structures during laparoscopic cholecystectomy Reduced risk of bile duct injury, improved visualization
Neuroma Evaluation ICG fluorescence angiography to assess neuroma perfusion Improved intraoperative decision-making for neuroma excision

FAQ

  • What is Indocyanine Green (ICG)? Indocyanine Green is a medical dye that can be injected into the bloodstream. It fluoresces under near-infrared light, allowing doctors to visualize blood flow and tissue structures during procedures.
  • How is ICG being used in cancer surgery? ICG is being studied to help surgeons better visualize tumors and lymph nodes during cancer operations. This may allow for more precise tumor removal and lymph node mapping in cancers like cervical, gastric, and pediatric solid tumors.
  • Can ICG help with lymphedema assessment? Yes, ICG lymphography is being evaluated as a quick, radiation-free way to visualize lymph flow in real-time. This may improve diagnosis and monitoring of lymphedema.
  • How might ICG improve liver transplant outcomes? Researchers are studying if ICG clearance tests can help assess liver graft viability during organ retrieval and predict post-transplant liver function recovery.
  • Are there any risks to using ICG? ICG is generally considered safe, but as with any medical procedure, there can be risks. Patients should discuss potential side effects or allergic reactions with their doctor before receiving ICG.

Ongoing Clinical Trials on Indocyanine Green

  • Study on Indocyanine Green for Evaluating Surgical Margins in Patients Undergoing Breast-Conserving Surgery for Early Invasive Breast Cancer

    Recruiting

    1 1 1
    Investigated diseases:
    Investigated drugs:
    Belgium

  • Study on Using Indocyanine Green for Detecting Residual Disease in Head and Neck Cancer Surgery

    Recruiting

    1 1 1
    Investigated diseases:
    Investigated drugs:
    Belgium France

  • Study on Indocyanine Green in Axillary Lymph Nodes for Patients with Breast Cancer and Metastatic Lymph Nodes

    Recruiting

    1 1 1
    Investigated diseases:
    Investigated drugs:
    Italy

  • Indocyanine Green Fluorescence Imaging for Flap Perfusion in Head and Neck Cancer Reconstruction Surgery

    Not yet recruiting

    1 1 1 1
    Investigated diseases:
    Investigated drugs:
    Sweden

  • Indocyanine Green and Near-Infrared Fluorescence for Lymph Node Removal in Children with Renal Tumours or Paratesticular Rhabdomyosarcoma

    Not yet recruiting

    1 1 1
    Investigated diseases:
    Investigated drugs:
    The Netherlands

  • A Study Using Indocyanine Green Fluorescence Imaging to Help Surgeons Better Identify Tumor Edges During Cancer Surgery in Patients with Solid Tumors

    Not yet recruiting

    1 1 1 1
    Investigated diseases:
    Investigated drugs:
    The Netherlands

  • Study of Indocyanine Green Angiography to Prevent Hypoparathyroidism in Patients Undergoing Total Thyroid Removal

    Not yet recruiting

    1 1 1 1
    Investigated diseases:
    Investigated drugs:
    France

  • Study on Using Indocyanine Green to Protect Parathyroid Glands During Thyroid Surgery for Patients with Hypothyroidism

    Not yet recruiting

    1 1 1 1
    Investigated diseases:
    Investigated drugs:
    Spain

  • Study on the Use of Indocyanine Green to Assess Lymphatic Vessel Porosity in Women with Lipedema

    Not recruiting

    1 1 1 1
    Investigated drugs:
    Belgium

  • Study Comparing Sentinel Node Policy with Current Staging Protocols in Early Stage Endometrial Cancer Using Patent Blue, Technetium (99mTc) Rheniumsulfide, and Indocyanine Green

    Not recruiting

    1 1 1 1
    Investigated diseases:
    Investigated drugs:
    France

Glossary

  • Indocyanine Green (ICG): A medical dye that fluoresces under near-infrared light, used to visualize blood flow and tissue structures during medical procedures.
  • Fluorescence angiography: An imaging technique that uses ICG and near-infrared light to visualize blood vessels and tissue perfusion.
  • Lymphedema: Swelling caused by a buildup of lymph fluid in the body's tissues, often occurring after lymph node removal or damage.
  • Sentinel lymph node: The first lymph node(s) to which cancer cells are likely to spread from a primary tumor.
  • Laparoscopic cholecystectomy: A minimally invasive surgical procedure to remove the gallbladder using small incisions and a camera.
  • Bile duct: A tube that carries bile from the liver and gallbladder to the small intestine.
  • Neuroma: A growth or tumor of nerve tissue, often painful and resulting from nerve injury.
  • Plasma disappearance rate (PDR): The rate at which a substance, like ICG, is cleared from the blood plasma.
  • Early allograft dysfunction (EAD): Poor function of a transplanted organ (allograft) in the early post-transplant period.
  • Calot's triangle: An anatomical area bounded by the cystic duct, common hepatic duct, and inferior edge of the liver, important in gallbladder surgery.

References

  1. https://clinicaltrials.gov/study/NCT06002906
  2. https://clinicaltrials.gov/study/NCT01771666
  3. https://clinicaltrials.gov/study/NCT02570815
  4. https://clinicaltrials.gov/study/NCT02570958
  5. https://clinicaltrials.gov/study/NCT03745690
  6. https://clinicaltrials.gov/study/NCT02876874
  7. https://clinicaltrials.gov/study/NCT04987281
  8. https://clinicaltrials.gov/study/NCT05645523
  9. https://clinicaltrials.gov/study/NCT05332405