# Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients — GCMD Library Dr. Sophia Schermerhorn from Cincinnati Children's discusses a multicenter prospective study on the accuracy of indocyanine green (ICG) for sentinel lymph node mapping in pediatric and adolescent patients with skin and soft tissue malignancies. The study, conducted by PSORC, found nearly 80% sensitivity for ICG in detecting sentinel nodes, with all malignant nodes being ICG-avid. ICG demonstrated a favorable safety profile with no adverse reactions within 30 days, avoiding the permanent tattooing sometimes seen with blue dye. This research supports ICG as an attractive visualization adjunct for pediatric sentinel lymph node biopsy, often used in conjunction with standard localization techniques.


Sophia M V Schermerhorn, Emily Vore, Alexander J Bondoc, Timothy B Lautz, Samantha A Ayala, Zachary J Kastenberg, Cameron Arkin, Marcus M Malek, Insiyah Campwala, Jennifer H Aldrink, Kyle Z Horvath, Nelson Piché, Yasmin Osman, Erin G Brown, Kathleen Doyle, Paige Abril, Jonathan P Roach, Ioannis A Ziogas, Daniel S Rhee, Charbel Chidiac, Stephanie F Polites, Julia Debertin, Brian T Craig, Dave R Lal, Eugene S Kim, William G Lee, Aaron Barkhordar, Hau D Le, Devashish Joshi, Michael Stellon, Elisabeth T Tracy, Catherine Beckhorn, Dafydd A Davies, Chloé Boehmer, Roshni Dasgupta

Background
Sentinel lymph node (SLN) biopsy is a critical staging tool in skin and soft tissue cancers. Although technetium lymphoscintigraphy is the most common adjunct, indocyanine green (ICG) demonstrates a promising alternative in pediatric, adolescent, and young adult (AYA) skin and soft tissue cancers.

Methods and Objectives
Evaluate the safety and efficacy of ICG in SLN biopsy (SLNB) in diverse pediatric and AYA solid cancers in a multi‐institutional environment. This is a prospective, observational study conducted at 13 member institutions in the Pediatric Surgical Oncology Research Collaborative between 2019 and 2023. Eligible patients underwent SLNB for primary or recurrent solid skin and soft tissue tumors. Peritumoral ICG was administered intraoperatively. Outcomes included SLN detection rates, histopathology of excised specimens, and surgeon‐reported assessment of utility. Safety was assessed through adverse event reporting.

Results
Forty SLNB procedures yielded 84 specimens: 13 melanoma (32.5%), 12 squamous cell carcinoma (30%), 11 non‐rhabdomyosarcoma soft tissue sarcoma (27.5%), two rhabdomyosarcoma (5%), one Ewing sarcoma (2.5%), and one malignant peripheral nerve sheath tumor (2.5%). Histologic evaluation identified 81 lymph nodes, 75 benign (89.3%) and six malignant (7.1%); three specimens were adipose tissue (3.6%). Of 81 lymph nodes, 76% were ICG‐positive. ICG had a sensitivity of 79.5%, a specificity of 33%, and a positive predictive value of 96%. All malignant nodes were ICG‐avid. There were no adverse reactions to ICG at 30 days.

Conclusions
ICG is a safe and effective adjunct for SLNB in pediatric and AYA soft tissue and skin malignancies.
Type: video · 1 min · posted 2026-05-18 Canonical: https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056 ## Chapters - [0:00](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=0) ICG for Sentinel Lymph Node Mapping in Pediatric Oncology ## Statements - "The study was a multi-center prospective study conducted by PeaceOC evaluating indocyanine green (ICG) for identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies" — Sophia Schermerhorn (clinical) [0:05](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=5) - "Peritumoral injection of ICG demonstrated almost 80% sensitivity for detecting a sentinel node" — Sophia Schermerhorn (clinical) [0:21](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=21) - "All sentinel nodes that contained malignancy were ICG avid" — Sophia Schermerhorn (clinical) [0:28](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=28) - "ICG diagnostic performance is similar to smaller pediatric studies previously evaluating ICG and sentinel lymph node biopsy" — Sophia Schermerhorn (clinical) [0:33](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=33) - "ICG may outperform blue dye localization based on previously reported literature" — Sophia Schermerhorn (opinion) [0:33](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=33) - "The study did not directly compare the effectiveness of ICG to blue dye localization" — Sophia Schermerhorn (clinical) [0:45](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=45) - "ICG in most cases was used in conjunction with standard localization techniques such as technetium" — Sophia Schermerhorn (clinical) [0:49](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=49) - "No adverse reactions to ICG were identified within 30 days of surgery" — Sophia Schermerhorn (clinical) [0:58](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=58) - "Blue dye can cause permanent tattooing" — Sophia Schermerhorn (clinical) [1:02](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=62) - "ICG has a favorable safety profile and lacks the permanent tattooing associated with blue dye, making it an attractive visualization adjunct for pediatric sentinel lymph node biopsy" — Sophia Schermerhorn (opinion) [1:02](https://library.globalcastmd.com/watch/indocyanine-green-assists-with-sentinel-lymph-node-mapping-in-pediatric-and-adolescent-patients-12056?t=62) ## Transcript So just how accurate is ICG for detecting sentinel lymph nodes in pediatric oncology? Hi, I'm Doctor Sophia Schermerhorn from Cincinnati Children's, and in this multi-center prospective study by PeaceOC, we evaluated endocyanin green, also known as ICGs, safety and effectiveness in identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies. Overall, peritumoral injection of ICG demonstrated. Almost an 80% sensitivity for detecting a sentinel node. In addition, all sentinel nodes that contained malignancy were ICG avid. This diagnostic performance is similar to smaller pediatric studies that have done previously evaluating ICG and sentinel lymph node biopsy and may outperform blue dye localization based on previously reported literature. However, it's important to note that this study did not directly compare the effect. effectiveness of ICG compared to blue dye localization and ICG in most cases was used in conjunction with standard localization techniques such as technetium. Importantly, we identified no adverse reactions within 30 days of surgery. This favorable safety profile, along with the lack of permanent tattooing that can sometimes be seen with blue dye, makes ICG an attractive visualization adjunct that can be used for pediatric sentinel lymph node biopsy. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai