Matteucci et al — ICG vs Tc-99m Meta-Analysis
Verified verbatim
This meta-analysis confirms that ICG fluorescence imaging is a reliable and effective technique for intraoperative SLN visualization in cutaneous melanoma. However, the available evidence primarily supports its role as an adjunctive intraoperative tool rather than as a complete replacement for Tc-99m. The frequent reliance on ex vivo fluorescence assessment and the widespread combined use of ICG with Tc-99m limit conclusions regarding the standalone performance of ICG-NIR across all clinical scenarios. Accordingly, conclusions suggesting equivalence between ICG-NIR and Tc-99m should be interpreted with caution… Further prospective studies specifically designed to evaluate ICG as a standalone modality, with standardized protocols and long-term oncologic follow-up, are needed before its routine use as a full alternative to Tc-99m can be recommended.
My take
The most important counterweight in the whole vault to an “ICG-alone” framing — this is the citation to use when arguing our case supports ICG as complementary/decisive-but-not-solo. See Open Questions - ICG Alone vs Complementary Framing.