Introduction: Indocyanine green (ICG) is frequently used in thoracic surgery, serving various purposes such as identifying the intersegmental plane (ISP) during segmentectomies, locating pulmonary nodules, or facilitating lymph node mapping. This systematic review aims to evaluate the effectiveness of ICG in facilitating these three procedures.

Methods: A systematic review of MEDLINE, EMBASE, PUBMED, Web of Science and Cochrane databases was performed according to PRISMA guidelines. Searches were conducted up to March 2024 to identify relevant studies. Studies were searched for identification rates using ICG, accuracy of nodule localization, and reliability of sentinel lymph node detection.

Results: From an initial 2,228 studies identified, a total of 30 studies met the inclusion criteria. These included 11 studies on ISP identification, 9 studies lung nodule localization, and 10 studies on sentinel lymph node identification. The use of ICG demonstrated varied identification rates, from 94% to 100% for ISP, 86% to 100% for lung nodule localization, and 44% to100% for lymph node mapping. The accuracy of ICG in detecting lung nodules varied from 80% to 89%, and the predictive accuracy for pathological lymph node status varied from 97% to 100%.

Conclusion: ICG emerges as a versatile dye that facilitates surgical precision even if it lacks specificity. The easy implementation of ICG is particularly advantageous for ISP identification. However, its accuracy for lung nodule localization should be improved for wider application. The use of ICG also holds promise for sentinel lymph node identification. Further research is needed to improve its detection rate.