The Diagnostic Effect of Intraoperative Indocyanine Green Imaging for Endometriosis: A Systematic Review and Meta-Analysis

Yuan Zhuang, Honghui Ou, Yue Xu, Hua Yang
In: Clinical and Experimental Obstetrics & Gynecology · 2024 · vol. 51(7) · doi:10.31083/j.ceog5107153 · W4400592831
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review found that intraoperative indocyanine green imaging showed some benefit for visualizing occult endometriosis but was not superior to white light imaging.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This paper is a systematic review and meta-analysis evaluating the diagnostic performance of intraoperative indocyanine green (ICG) imaging versus white light (WL) imaging for identifying endometriosis lesions during laparoscopic surgery. The authors searched multiple databases through January 2024 and included six comparative clinical studies totaling 223 patients, using histopathology as the gold standard, and extracted measures such as sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooled results showed that sensitivity was higher for WL (0.88) than for ICG (0.64), while specificity was similar (WL 0.85; ICG 0.88), with both approaches yielding LR+ around 5–6; overall ICG was not superior to WL. The authors explicitly caution that the number of included publications was limited and that additional larger multicenter studies are needed. This paper is centrally about endometriosis—specifically comparing intraoperative ICG imaging to white light for detecting occult endometriosis lesions.

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Abstract

Background: To comprehensively investigate the diagnostic effect of intraoperative indocyanine green (ICG) imaging for endometriosis (EMs). Methods: We systematically retrieved relevant literature from a series of databases (Embase, Web of Science, PubMed, Clinical Trials, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and WanFang Database) up to January 2024. We also performed manual searches using the reference lists from selected articles, along with reports from relevant meetings and Google Scholar. Data were stored and analyzed by Review Manager version 5.3 and Stata/MP version 14.0. Results: Systematic searches of the literature identified six articles comparing the diagnostic effect of ICG imaging to white light (WL) imaging for EMs during laparoscopic surgery. Two of these studies found that ICG imaging improved the diagnostic rate of EMs while the remaining four studies reported that the diagnostic value of ICG imaging was minimal. Cumulative analysis determined that the sensitivity was 0.88 (95% confidence interval [95% CI]: 0.81–0.93) for WL and 0.64 (95% CI: 0.36–0.84) for ICG. The specificity was 0.85 (95% CI: 0.49–0.97) for WL and 0.88 (95% CI: 0.66–0.97) for ICG. The positive likelihood ratio (LR+) was 5.8 (95% CI: 1.4–24.5) for WL and 5.4 (95% CI: 1.2–24.1) for ICG. The negative likelihood ratio (LR–) was 0.14 (95% CI: 0.09–0.20) for WL and 0.41 (95% CI: 0.18–0.94) for ICG, while the diagnostic odds ratio (DOR) was 42 (95% CI: 10–182) for WL and 13 (95% CI: 1–124) for ICG. Conclusions: Although we only analyzed a limited number of publications, our analysis demonstrated that ICG may be helpful for the visualization of occult EMs, although the diagnostic effect of ICG is not superior to WL. Our findings need to be confirmed by additional studies involving larger sample sizes from multiple centers.

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endometriosis

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