Singapore’s Changi General Hospital is using Indocyanine Green (ICG) fluorescence imaging to detect lymphoedema early, transforming how breast cancer survivors are monitored, treated, and supported long after remission.
As survival rates for breast cancer continue to climb, a quieter battle often begins long after remission.
For up to one in five survivors, swelling, discomfort, and restricted mobility become daily companions which are the symptoms of a chronic condition known as lymphoedema.
Despite its prevalence, the condition remains under-recognised across Asia, often diagnosed only after irreversible damage has set in.
Now, Singapore’s Changi General Hospital (CGH) is pioneering a new approach that could change that narrative.
Through the use of Indocyanine Green (ICG) fluorescence imaging, doctors can detect lymphoedema at its earliest stages, offering hope for earlier, more effective treatment and a better quality of life for survivors.
Seeing the Unseen
Traditional diagnostic methods, such as limb-volume measurement or radioactive lymphoscintigraphy, have long struggled with limitations in sensitivity and accessibility.
ICG, by contrast, provides a live, glowing map of the lymphatic system within minutes. When illuminated under near-infrared light, the dye outlines vessels and flow patterns invisible to the naked eye.
“ICG lymphography has revolutionised how we detect and manage breast-cancer-related lymphoedema,” says Dr Jeremy Sun Mingfa, Consultant Surgeon and Director of the Lymphoedema Service at Changi General Hospital (CGH).
“It’s faster, safer, and more precise. Patients can be screened in-clinic on the same day as consultation, without radiation exposure or the need for a nuclear facility.”
At CGH, lymphoedema screening with ICG is now part of routine survivorship care.
Patients undergo scans every six months, an approach that has already shown measurable results.
According to Dr Sun, over 70 per cent of potential cases are now caught early, and more than half are successfully managed with conservative therapy alone.
From Reactive to Proactive Care
Early detection marks a shift in philosophy: instead of waiting for swelling to appear, doctors are moving toward preventive surveillance.
The benefit is not only clinical but psychological. Patients gain reassurance that subtle symptoms are being tracked, not ignored.
Dr Sun emphasises that this mindset must extend beyond hospitals. “Lymphoedema can develop years after treatment, sometimes even a decade later. We need a coordinated system that educates both healthcare professionals and patients to recognise that it’s a treatable condition, especially when caught early.”
The Technology Behind the Glow
While ICG has existed for decades in liver and cardiac imaging, companies such as UltraGreen.ai are driving its next evolution.
The Singapore-based manufacturer supplies high-purity ICG dye worldwide and partners with hospitals and surgeons to integrate fluorescence imaging into daily practice.
“ICG helps surgeons see beyond the limits of the human eye,” says Fidelma Margaret Callanan, Chief Commercial Officer (Ex Americas) at UltraGreen.ai.
“When viewed through a near-infrared camera, well-perfused tissue glows bright while poorly perfused areas remain dark, providing real-time information that guides surgical precision.”
The dye’s reliability lies in its simplicity: it is metabolised by the liver, excreted through bile, and adverse reactions are exceedingly rare, about one in 40 000 cases globally.
Combined with its versatility, ICG has become a workhorse across specialities, from sentinel lymph-node mapping in cancer to assessing tissue viability in reconstructive surgery.
UltraGreen is also developing quantitative fluorescence software that converts visual brightness into measurable data. Callanan explains, “The next frontier is objectivity.”
“Quantification will give surgeons standardised metrics rather than relying solely on what they see, enabling AI-assisted decision-making and better reproducibility.”
Barriers and Breakthroughs
Despite its promise, fluorescence imaging is not yet universal. The cost of specialised near-infrared cameras and limited clinician training remain hurdles.
UltraGreen and its partners are addressing these through lower-cost imaging options for outpatient use and hands-on workshops across Asia.
Experts believe accessibility will accelerate adoption, particularly in countries where post-treatment monitoring is inconsistent.
As awareness grows, fluorescent dye imaging could become a routine component of cancer survivorship programs, much like mammography for screening.
Beyond Breast Cancer
The same technology is expanding into other areas.
In reconstructive surgery, ICG helps verify blood flow in transplanted tissue, reducing failure rates. It is also being studied in diabetic wound management and vascular surgery, where real-time perfusion imaging could guide intervention and reduce complications.
These diverse applications signal a future where fluorescence is not confined to the operating theatre but part of holistic, data-driven care pathways.
Lighting the Future of Survivorship
For patients, this represents a new era of prevention, where a once-inevitable complication becomes manageable, or even avoidable.
For clinicians, it represents a step toward precision medicine grounded in visibility and evidence.
“Cancer care doesn’t end when the tumour is removed,” Dr Sun reflects. “By embracing tools like ICG, we can safeguard patients’ long-term wellbeing, not just their immediate recovery.”
And as Callanan adds, “Technology is only transformative when paired with education. The more clinicians trained in fluorescence imaging, the more lives, and limbs that we can protect.”
From Singapore’s hospitals to surgical theatres worldwide, fluorescent dye technology is quietly illuminating a new era in cancer survivorship, one where seeing the unseen might just make all the difference.
