Indocyanine Green Fluorescence in Oncologic Surgery: A Critical Review of Sentinel Lymph Node Mapping and Tumor Margin Assessment

Objective: To critically evaluate current evidence regarding the clinical utility, effectiveness, and limitations of indocyanine green (ICG) fluorescence imaging in oncologic surgery, with particular emphasis on sentinel lymph node mapping and tumor margin assessment. Methods: A narrative literature review was conducted using the PubMed database. Studies published between 2013 and 2025 were analyzed, including clinical studies, randomized trials, systematic reviews, meta-analyses, consensus statements, and methodological papers addressing oncologic applications of ICG fluorescence imaging. Results: Strong evidence supports the use of ICG fluorescence imaging in sentinel lymph node mapping across colorectal, gastric, breast, and gynecologic cancers. The technique improves visualization of lymphatic pathways and facilitates intraoperative navigation. Evidence regarding tumor margin assessment remains heterogeneous, with diagnostic performance limited by the non-specific accumulation of ICG and variability among imaging protocols. Conclusions: ICG fluorescence imaging is an effective and increasingly valuable tool in oncologic surgery, particularly for sentinel lymph node mapping. However, its role in tumor margin assessment remains less established. Further standardization and development of tumor-specific fluorescence agents are required to optimize clinical applications.