A systematic review of the application of indocyanine green in pancreatic neuroendocrine tumors: Technical details, surgical indications, and outcomes

BACKGROUND: Intraoperative localization of pancreatic neuroendocrine tumors (pNETs) is challenging, particularly for small lesions during minimally invasive surgery due to the lack of tactile feedback. Indocyanine green (ICG) fluorescence imaging is a promising technique to enhance tumor visualization and surgical guidance. This systematic review evaluates current evidence on ICG use in pNET surgery, focusing on indications, timing, dosage, and intraoperative strategies. METHODS: A systematic search of PubMed, Embase, and Web of Science was conducted up to May 2025, following PRISMA guidelines. Included studies reported intraoperative ICG use in pNET surgery. Preclinical studies, non-English articles, and those lacking data on ICG protocol or dosage were excluded. RESULTS: Fifteen studies involving 43 patients were included. Diagnoses were insulinoma (39.5 %), unspecified pNETs (58.2 %), and one case of neuroendocrine hyperplasia. ICG identified tumors in 88.4 % of cases, with a positive predictive value of 95.0 %. ICG was mostly administered intravenously after pancreatic exposure, with doses ranging from 1 to 25 mg. Fluorescence appeared within 5 min and was homogeneous in 97.4 % of cases. No adverse events were reported. DISCUSSION: ICG fluorescence is a safe and effective tool for localizing pNETs. Further studies are needed to standardize protocols and optimize clinical use.