Systematic review and meta-analysis on the diagnostic accuracy of indocyanine green angiography for skin viability assessment: Evaluation in post-mastectomy flaps
In brief
Negative indocyanine green scans predicted viable mastectomy flaps 95% of the time
In a meta-analysis of 10 studies of post-mastectomy flaps, a negative indocyanine green angiography result corresponded to viable skin in about 95% to 97% of cases. Overall accuracy was moderate, and positive results had a low predictive value: only about one in five flagged areas developed necrosis. Accuracy in other procedures and body sites remains unknown.
- Journal
- Journal of plastic, reconstructive & aesthetic surgery : JPRAS (Q1)
- Published
- 17 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Jesse de Haan, Lidewij M F H Neeter, Anouk Pijpe, Gisela R H M Moormann, Paul P M van Zuijlen, N J Harlaar, et al.
- PMID
- 42879877
- DOI
- 10.1016/j.bjps.2026.09.018
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 16 October 2026): Diagnostic accuracy of indocyanine green angiography for skin viability
Abstract
BACKGROUND: Indocyanine green angiography (ICGA) is frequently used to assess skin viability; however, there is no clear overview of its diagnostic accuracy. This systematic review and meta-analysis aimed to synthesize evidence on the diagnostic accuracy of ICGA for skin viability assessment, compare quantification methods, and identify clinically relevant cut-off values. METHODS: A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases up to October 2025. Studies were included if raw diagnostic ICGA data for skin viability assessment were retrievable. Study quality was assessed using the QUADAS-2 tool. Pooled sensitivity, specificity, predictive values, and cut-off values were identified for absolute and relative perfusion using the bivariate random-effects and multiple-threshold models. RESULTS: Twelve studies were included, of which 10 were pooled in the quantitative synthesis. All 10 studies evaluated post-mastectomy flaps. The reference standard was the postoperative clinical evaluation of skin necrosis. Using multiple-threshold analysis, the pooled sensitivity for absolute perfusion cut-offs (6 studies) was 85.1% (95% CI: 61.9-95.2%) and pooled specificity was 61.4% (95% CI: 43.2-77.0%), with an area under the curve (AUC) of 0.77. For relative perfusion (5 studies), the pooled sensitivity was 68.4% (95% CI: 32.2-90.8%) and pooled specificity was 69.1% (95% CI: 45.2-85.8%), with an AUC of 0.74. The pooled negative predictive value was high (94.7-97.1%), whereas the pooled positive predictive value was low (21.3%) at the observed necrosis rate of 10.9%. The identified cut-off values were 18.3 for absolute perfusion and 31.7% for relative perfusion. CONCLUSIONS: ICGA demonstrated moderate diagnostic accuracy for assessing skin viability of post-mastectomy flaps. Its diagnostic performance for the skin in other locations and procedures is yet to be established.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.