Indocyanine green (ICG) fluorescence imaging has become an essential tool in immediate breast reconstruction, enabling real-time assessment of mastectomy skin flap perfusion and supporting intraoperative decision-making. In the EMEA region, standardized ICG dosing protocols are critical to ensure consistent imaging quality and optimal surgical outcomes.
This guideline provides procedure-specific recommendations for ICG dosing and timing in immediate breast reconstruction, based on expert consensus from the International Society for Fluorescence Guided Surgery (ISFGS). By defining key parameters such as injection route, dosage, and detection timing, surgeons can enhance visualization of tissue vascularization and reduce the risk of complications such as flap necrosis.
ICG angiography has demonstrated strong clinical value in improving perfusion assessment and reducing postoperative complications, reinforcing its role as a standard adjunct in modern reconstructive breast surgery.
Sección:
Tabla:
Columna1:
Region of interest
, Contenido:
Skin and autologous flap
Columna1:
Dose
, Contenido:
7.5 mg bolus
Columna1:
Route
, Contenido:
I.V.*
Columna1:
Injection time
, Contenido:
Intraoperatively
Columna1:
First ICG detection
, Contenido:
60-120 sec
Columna1:
ICG Duration
, Contenido:
2-4 min
Columna1:
Camera requirements
, Contenido:
NIR light source camera
Columna1:
References (full ref details at end of this guide doc)
, Contenido:
1. 2018, Alstrup et al.,
Tabla:
Columna1:
Region of interest
, Contenido:
Skin and autologous flap
Columna1:
Dose
, Contenido:
7.5 mg bolus
Columna1:
Route
, Contenido:
I.V.*
Columna1:
Injection time
, Contenido:
Intraoperatively
Columna1:
First ICG detection
, Contenido:
60-120 sec
Columna1:
ICG Duration
, Contenido:
2-4 min
Columna1:
Camera requirements
, Contenido:
NIR light source camera
Columna1:
References (full ref details at end of this guide doc)
Indocyanine green (ICG) fluorescence imaging is widely used in mastectomy to assess skin flap perfusion and guide intraoperative decisions. By providing real-time visualization of tissue vascularization, this technique helps identify areas at risk of ischemia and supports surgical planning.
In the EMEA region, standardized dosing and timing protocols improve consistency in fluorescence imaging and contribute to reducing complications such as mastectomy skin flap necrosis and reoperation rates.
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Tabla:
Columna1:
Region of interest
, Contenido:
Skin
Columna1:
Dose
, Contenido:
0.2 mg/kg
Columna1:
Route
, Contenido:
I.V.*
Columna1:
Injection time
, Contenido:
Intraoperatively
Columna1:
First ICG detection
, Contenido:
30-60 sec
Columna1:
ICG Duration
, Contenido:
3-4 min
Columna1:
Camera requirements
, Contenido:
Laparoscope, NIR light source camera
Columna1:
References (full ref details at end of this guide doc)
Indocyanine green (ICG) fluorescence imaging is widely used in breast cancer surgery for sentinel lymph node mapping and lymphatic visualization. This technique enables accurate identification of nodal drainage pathways, supporting precise staging while reducing the need for extensive lymph node dissection.
Clinical evidence shows that ICG provides high detection rates and can be comparable or superior to conventional methods such as blue dye or radioisotopes, while avoiding their limitations.
In the EMEA region, standardized dosing and timing protocols help ensure consistent fluorescence imaging and improve intraoperative decision-making in breast cancer surgery.
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Tabla:
Columna1:
Region of interest
, Contenido:
Sentinel Lymph Node (SLN)
Columna1:
Dose
, Contenido:
2 mL (2.5 mg/mL) (2-4 injection sites)
Columna1:
Route
, Contenido:
I.D. into lateral areolar region
Columna1:
Injection time
, Contenido:
After induction of anaesthesia with subsequent breast massage
Columna1:
First ICG detection
, Contenido:
Beginning of surgery
Columna1:
ICG Duration
, Contenido:
Remains visible during procedure as it diffuses slowly via lymphatics
Columna1:
Camera requirements
, Contenido:
Open procedure, NIR light source camera
Columna1:
References (full ref details at end of this guide doc)
Indocyanine green (ICG) fluorescence imaging is widely used in lower limb lymphedema to visualize lymphatic flow and assess the severity of lymphatic dysfunction. This technique enables real-time mapping of superficial lymphatic vessels, supporting accurate diagnosis, staging, and surgical planning.
ICG lymphangiography has demonstrated high sensitivity and specificity compared to conventional imaging, allowing precise identification of functional lymphatic channels and guiding procedures such as lymphaticovenular anastomosis.
In the EMEA region, standardized dosing and timing protocols help ensure consistent fluorescence imaging and improve intraoperative decision-making in the management of lower limb lymphedema.
Sección:
Tabla:
Columna1:
Region of interest
, Contenido:
Lymphatic vessels
Columna1:
Dose
, Contenido:
0.05–0.1 mL (0.125-0.25 mg/mL)
Columna1:
Route
, Contenido:
Intra-dermal
Columna1:
Injection time
, Contenido:
Beginning of assessment
Columna1:
First ICG detection
, Contenido:
Beginning of assessment
Columna1:
ICG Duration
, Contenido:
Lymph flow tracked for 1 hr
Columna1:
Camera requirements
, Contenido:
NIR light source camera
Columna1:
References (full ref details at end of this guide doc)
Indocyanine green (ICG) fluorescence imaging is increasingly used in melanoma surgery for sentinel lymph node mapping and lymphatic visualization. Sentinel lymph node biopsy is a critical step in staging melanoma, allowing accurate assessment of nodal involvement and guiding further treatment decisions.
ICG-based near-infrared imaging enables real-time visualization of lymphatic drainage pathways and has demonstrated comparable detection rates to conventional techniques such as radiocolloid and blue dye, while improving intraoperative guidance.
In the EMEA region, standardized dosing and timing protocols help ensure consistent fluorescence imaging and support precise, minimally invasive surgical approaches in melanoma management.
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Tabla:
Columna1:
Region of interest
, Contenido:
SLN
Columna1:
Dose
, Contenido:
Head & Neck 0.1-0.3 mL Elsewhere 0.2-0.3 mL (2.5 mg/mL)
Columna1:
Route
, Contenido:
Intra-dermal
Columna1:
Injection time
, Contenido:
Intra-operatively
Columna1:
First ICG detection
, Contenido:
Beginning of assessment
Columna1:
ICG Duration
, Contenido:
Remains visible during procedure
Columna1:
Camera requirements
, Contenido:
NIR light source camera
Columna1:
References (full ref details at end of this guide doc)
Indocyanine green (ICG) fluorescence imaging is increasingly used in breast cancer surgery to visualize lymphatic drainage, identify sentinel lymph nodes, and assess tissue perfusion during reconstruction. Proper dosing and timing of ICG administration are essential to achieve optimal near-infrared fluorescence imaging during the procedure.
This dosing and timing chart provides practical guidance for ICG use in breast cancer surgery, including recommended injection techniques, dosage ranges, and expected fluorescence detection times for sentinel lymph node mapping and breast reconstruction perfusion assessment.
Indocyanine green (ICG) fluorescence imaging is widely used in breast reconstruction to assess perfusion of mastectomy skin flaps and support intraoperative decision-making. Near-infrared fluorescence angiography allows surgeons to visualize real-time blood flow and identify areas at risk of ischemia during reconstructive procedures.
This dosing and timing chart outlines recommended ICG administration for breast reconstruction, including intravenous injection protocols, dosage guidance, and expected fluorescence detection times. These parameters help optimize intraoperative perfusion assessment and improve surgical outcomes during reconstructive breast surgery.
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Title: Dosing & Timing Chart, Tabla:
Columna1:
Purpose:
, Contenido:
Mastectomy skin flaps perfusion
Columna1:
Injection Type:
, Contenido:
Intravenous
Columna1:
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL):
, Contenido:
Yes
Columna1:
Requires Flush with Sterile Water:
, Contenido:
Yes
Columna1:
Proposed Dosage:
, Contenido:
1 mL
Columna1:
Injection Time:
, Contenido:
During skin flap manipulation and reconstruction.
Columna1:
First Indocyanine Green Detection:
, Contenido:
30–60 seconds after administration
Columna1:
Indocyanine Green Duration:
, Contenido:
60 s–3 mins
Columna1:
Camera Requirements (handheld device, laparoscope or both):
, Contenido:
Handheld
Columna1:
Tips & Tricks:
, Contenido:
Adjunct to clinical assessment and surgical symmetry.
Indocyanine green (ICG) fluorescence imaging is widely used to visualize lymphatic vessels and assess lymphatic drainage in patients with lymphedema. Near-infrared fluorescence imaging allows surgeons and clinicians to map lymphatic pathways in real time, supporting diagnosis and guiding microsurgical procedures such as lymphaticovenous anastomosis.
This dosing chart provides guidance on recommended ICG administration for lymphedema imaging, including subcutaneous injection techniques, dosage considerations, and expected fluorescence detection to optimize lymphatic mapping using near-infrared fluorescence imaging.
Sección:
Title: Dosing & Timing Chart, Contenido:
*For 0.1 and 0.2 mL doses, utilize an insulin syringe to draw/administer volumen.
, Tabla:
Columna1:
Purpose:
, Contenido:
Lymph vessel assessment
Columna1:
Injection Type:
, Contenido:
Other
Columna1:
Description:
, Contenido:
Administration should be subcutaneous into bilateral interdigit hand or foot.
Columna1:
Dilution (25 mg in 10 mL of sterile water - 2.5mg/mL):
, Contenido:
Yes
Columna1:
Requires Flush with Sterile Water:
, Contenido:
No
Columna1:
Proposed Dosage:
, Contenido:
0.1 mL*
Columna1:
Injection Time:
, Contenido:
At time of lymph vessel evaluation
Columna1:
First Indocyanine Green Detection:
, Contenido:
Minutes after administration
Columna1:
Indocyanine Green Duration:
, Contenido:
Hours
Columna1:
Camera Requirements (handheld device, laparoscope or both):
, Contenido:
Handheld
Columna1:
Tips & Tricks:
, Contenido:
Gentle, circular motion massaging can be performed to distribute dye.
Título completo del paper: Indocyanine Green Is a Safe and Effective Alternative to Radioisotope in Breast Cancer Sentinel Lymph Node Biopsy regardless of Patient Body Mass Index
Autores: Samantha Nga, Vassilis Pitsinisa, Emad H. Elseedawya, Douglas Browna, Alessio Vincia, Benjamin A. Jonesa, E. Jane Macaskilla
Título completo del paper: Oncological outcomes and locoregional recurrence after fluorescence guided surgery for axillary staging in early breast cancer: A single UK center experience
Autores: Rahul Kanitkar, Vassilis Pitsinis, Bushra Riaz, Alessio Vinci, Fiona Hogg, Lee B. Jordan
Título completo del paper: Results of a Prospective Randomized Multicenter Study Comparing Indocyanine Green (ICG) Fluorescence Combined with a Standard Tracer Versus ICG Alone for Sentinel Lymph Node Biopsy in Early Breast Cancer: The INFLUENCE Trial
