| Objective:Breast cancer is the most common malignant tumor in women and threatening their health in worldwide.In recent years,the mobidity of breast cancer among Chinese women has been increasing year by year.According to statistics,there are about 249,000 new cases of breast cancer every year,which is the second only to the United States,and about 60,000 cancer-related deaths occurring in worldwide.Studies have shown that about 20%breast cancer shows a clinical negative palpation.The discovery of palpation negative breast cancer enables breast cancer to be diagnosed and treated at a low active level.Early diagnosis and treatment is of great significance and is the most important means to improve the prognosis of breast cancer.More and more patients ask for breast conserving surgery.Accurate intraoperative positioning is the key to achieve better therapeutic effeects,complete tumor resection and acceptable cosmetic effects.Now some technology is used in operation tumor positioning,such as 1.the traditional open surgery.2.Intra-operative ultrasound guided positioning.3.local dye position,4.Intra-operative wire-guided locolization method,5.radionuclide mapping method,but the existing methods shows as inaccurate positioning,the dye dispersion.displacement or deviation of the wire,radiation,postoperative complications,the patient discomfort,all have certain limitations,so looking for a new simple and convenient and efficient way of intraoperative localization is critical in beter diagnosis and treatment of the nonpalpable breast cancer.The purpose of this study is to evaluate the clinical value of indocyanine green fluorescence(ICG)imaging in the complete resection of nonpalpable breast cancer.Method:A retrospective analysis of 67 cases with preoperatively diagnosed NBCs and treated in our hospital from January 2012 to January 2019 were conducted.Intraoperative ICG injection fluorescence imaging system was used in all patients to check the tumor location.According to the postoperative pathological results,the pathological type of the tumor was det:ermined,and the clinical data such as the distance between the margin and the tumor,the volume of tissue resection,and the patholoeical negative rate of the margin were analyzed.Results:All the 67 patients were diagnosed bv ultrasound,and all the BIRADS were classified in more than 4 categories,including 23 on the left and 44 on the right.The minimum diameter of the lesion was 5mm,the maximum dian,eter was 25mm,and the mean value with a standard deviation was 15.1±6.8mm.All of the injection ICG guided by ultrasound was one-time success in preoperative.All taget injection mass parts was visible fluorescence under the fluorescent probe after 7-8 minutes,all purpose lesions show success,no loss,no false positive locolization,accurate positioning and visible fluorescence coverage all organizations was complete resected under the guidance of real-time intraoperative fluorescent photodynamic eye(PDE).During the operation,64/67(95.5%)of the patients with satisfactory operative margin.and 3(4.5%)of the patients with positive surgical margin required resection according to the intraoperation freezing pathology.Among them,two patients had intra ductal carcinoma in situ at the operative margin,which was expanded resection to obtain a satisfactory surgical margin,and only one patient underwent total mastectomy because it was difficult to obtain a good surgical margin due to multi-focal infiltration.The average volume of resected breast tissue was(49.61±20.13)cm3.The average operative time was(23.07±5.52)min.B-mode ultrasonography were performed postoperatively to confirm complete resection.Postoperative pathology indicated that 55 of the 67 patients were invasive ductal carcinoma,one was lobular carcinoma in situ,eight were intraductal carcinoma in situ,and three were other types.No obvious pain,wound infection,hematoma or other complications occurred.The patients were followed up to January 2019.and there was no local metastasis or recurrenceConclusion:The intraoperative ICG fluorescence localization system guided localization used in the nonpalpable breast cancer improved the process of tumor localization.It enables the nonpalpable breast lesions can be visible in the whole process of the operation;The location of the skin incision can be accurately determined;The near infrared fluorescence imaging system can identify the excision edge of breast lesions easily.It has the advantages in accurate positioning,less trauma and shorter operation time,which simplifies the clinical work and avoids the discomfort of preoperative guide wire positioning and the drawbacks of ultrasonic guided resection during rolling.Although further studies are needed to assess the feasibility and effectiveness of this technique,intraoperative ICG guidance has important application value in the intraoperative resection of nonpalpable breast cancer. |
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