Table 4. Summary of all clinical studies reporting the utility of ICG in detecting mastectomy skin flap necrosis in prosthesis-based breast reconstructions.
| Author | Year | Implants | Patient | Control | P/R | Device | Rate of implant-related necrosis (%) | Findings |
|---|---|---|---|---|---|---|---|---|
| Kanuri (99) | 2014 | 710 | 508 | N/A | R | SPY | 11.1 | Indiscriminate used of ICG is more expensive than the complication-related costs by 65% |
| Cost savings per flap necrosis prevented: USD 2,098.80 for smokers, USD 5,162.30 for BMI >30, USD 1,892.70 for mastectomy weight >800 g | ||||||||
| Duggal (94) | 2014 | N/A | 184 | 184 | R | SPY | 13 | ICG decreased necrosis (13% vs. 23.4%, P=0.01) |
| Cost savings per patient: USD 614 | ||||||||
| Munabi (101) | 2014 | 50 | 42 | N/ | P | SPY | 12 | SPY-Q perfusion unit ≤7.0: 88% sensitivity, 83% specificity |
| SPY-Q perfusion unit ≤10.0: 100% sensitivity, 72% specificity | ||||||||
| 18% false positive rate | ||||||||
| Phillips (93) | 2012 | 51 | 32 | N/A | P | SPY | 41.2 | ICG: 90% sensitivity, 50% specificity for necrosis |
| ICG overpredicts hypoperfusion by 66.57 cm2 | ||||||||
| SPY-Q perfusion unit <3.7: 90% sensitivity, 100% specificity for necrosis | ||||||||
| SPY-Q perfusion unit <8.0: 100% sensitivity, 70% specificity for necrosis | ||||||||
| Moyer (100) | 2012 | 15 | 14 | N/A | R | SPY | 14 | SPY-Q perfusion score ≤25%: 90% sensitivity for necrosis |
| SPY-Q perfusion score ≥45%: 98% sensitivity for survival | ||||||||
| SPY-Q perfusion score 33%: 88% PPV for necrosis, 16% NPV for survival | ||||||||
| Newman (102) | 2010 | 19 | 11 | N/A | R | SPY | 45 | 95% correlation between ICG and postoperative necrosis |
| 100% sensitivity, 91% specificity | ||||||||
| Komorowska-Timek (33) | 2010 | 16 | 12 | 148 | P | SPY | 4 | ICG decreased necrosis (4% vs. 15.1%, P<0.01) |
ICG, indocyanine green; P, prospective; R, retrospective; N/A, not available; BMI, body mass index; PPV, positive predictive value; NPV, negative predictive value.