| BACKGROUND: With the development of modern imaging technology and the improvement of people’s awareness for health examination,more and more early breast cancer has been found.Early stage of breast cancer is mostly asymptomatic.Because the lesion is small and can not be touched,it can only be found by imaging,which also increases the difficulty of surgical diagnosis.Early resection of these small lesions and pathological examination are of great significance for the diagnosis and treatment of breast cancer and the prognosis of patients.Objective: For these nonpalpable lesions,there are several techniques of intraoperative guidance of the excision,but wire-guided breast lesion localization(WL)is still considered the gold standard for intra-operative tumour localization.and it is also considered the gold standard for intra-operative tumour localizationby the world.The use of WL for the excision of non-palpable breast cancer also has several disadvantages.Therefore,we have explored a new guided localization technology-Indocyanine green fluorescence-guided excision technology(INBCL).The purpose of this study was to investigate whether the INBCL technology can have a greater advantage as a clinical guide as a new choice for clinically guided localized excision of non-palpable breast cancer.by comparing the application value of indocyanine green-guided non-palpable breast cancer lesion localization and wire localization 。Methods: A total of 94 patients with a preoperative histological diagnosis of non-palpable breast cancer lesions that could be visualized with ultrasound and mammography from September 2016 to December 2018 were randomized to the indocyanine green-guided non-palpable breast cancer lesion localization and wire localization groups.To study whether the indocyanine green-guided non-palpable breast cancer lesion localization has more advantageous than the wire localization by comparing the size of the resected tissue specimens of the non-palpable breast cancer,the margin of the breast cancer(if the margin is positive,then second cut of the margin is necessary),the time of the resection and the aesthetic effect after the breast surgery in the two groups.Patients with preoperatively diagnosed primary ductal carcinoma in situ and multifocal disease were excluded from the study.Significance was considered at p<0.05.Results: Of 94 excisions,46(48.9%)were guided by INBCL and 48(51.1%)were guided by WL.Both techniques resulted in 100% lesion retrieval.The rate of clear margins was significantly higher in the INBCL group(91.3%;42/46)than that inthe WL group(68.8%,33/48)(p=0.006),with fewer re-excisions required.When results of the excised tissue are taken into account,the mean volume of the INBCL specimen was23.38±13.35cm^3 less than that of the WL group,it was 32.79±19.79cm^3(p=0.002).although this was not significantly different(p=0.053).Indocyanine green guided resection of non-palpable breast cancer did not reduce the operation time more.The time was 31.41±3.62 minutes,while the time for guided wire positioning group was33.06±4.67 minutes.Ninety of the 94 patients underwent breast conservation therapy in the study.When cosmetic results were taken into account for these patients,39(86.7%)INBCL patients had excellent outcomes and 6(13.3%)had good outcomes,compared to 28(62.2%)excellent and 17(37.8%)good outcomes for the WL group(p=0.008).Conclusion: Both indocyanine green-guided non-palpable breast cancer lesion localization and wire localization groups can completely localize and resect non-palpable breast cancer.However,compared with wire localization,indocyanine green-guided localization has the advantages of lower negative rate of incision margin,smaller volume of resected specimens and better aesthetic effect after breast-conserving operation by making clear margin of the lesion during operation.It can be popularized as a new technique of intraoperative localization-guided excision for non-palpable breast cancer. |
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