| BackgroundNipple discharge,one of the common clinical symptoms in female breast diseases,accounts for about 4%-10%of the female breast diseases.Nipple discharge includes the physiological and pathological nipple discharge.Pathological nipple discharge is mainly caused by the benign lesions like breast hyperplasia and intraductal papilloma,the borderline lesions like breast dysplasia and the malignant lesions like breast cancer.Most nipple discharge diseases require the surgical treatment and the conventional galactography is a necessary examination before the surgery.Galactography can estimate the position and morphology of the pathological duct,assist in the design of an optimum surgical incision.Besides,the dye like methylene blue,can be injected in duct during the surgery to help identify the pathological duct and guide the selection of the surgical resection range.At present,as the conventional galactography cannot develop the imaging of pathological mammary duct in real time during the surgery,a new method of galactography for the application of the surgery is in demand.Indocyanine green is a clinical fluorescent tracer approved by the U.S.Food and Drug Administration(FDA).Indocyanine green can rapidly bind to proteins after being injected into the human body as well as absorb near-infrared light and produce the detectable fluorescence.Actually,it has been applied extensively to many kinds of surgery and the evaluation of liver function and blood vessel.The fluorescence imaging of vasculature system developed by indocyanine green can be clearly shown through the skin.Indocyanine green is widely used in sentinel lymph node biopsy of breast cancer in clinic.Similarly,the application of the indocyanine green can make the fluorescence imaging of mammary duct,which belongs to the subcutaneous duct system of breast,be theoretically observed through the skin.This paper intends to explore the application value of indocyanine green galactography in the nipple discharge surgeryObjectiveThe purpose of our study is to study the feasibility of locating the pathological ducts and marking the pathological mammary glands in the nipple discharge surgery through the application of indocyanine green galactography,to explore the influence factors of the performance of indocyanine green galactography,and to clarify the application value of indocyanine green galactography in the nipple discharge surgery.Materials and MethodsThe study collected the clinical data of 44 pathological breasts from 40 female patients who underwent the surgical treatment for nipple discharge in the department of breast surgery,Qilu Hospital of Shandong University from January to November in 2019.Conventional galactography was performed on all patients before the surgery,and all the galactography images were collected for the study.During the surgery,indocyanine green was used for galactography while the real-time fluorescence imaging was performed with a hand-held fluorescence detector.Through fluorescence imaging on the skin,the pathological mammary glands which were fluorescence marked would be completely removed along the designed surgical incision for pathological examination.The basic clinical data,pathological diagnosis and images of the galactography were collected after the surgery.The factors affecting ICG galactography were explored,and the application value of ICG galactography in the surgery of nipple discharge was evaluated.All the statistic analysis on the clinical data of patients with nipple discharge were processed with Microsoft Office 2016 software and IBM SPSS Statistics 22 software.And there is statistical significance in the difference when P<0.05 in the inspection result.Results1.In the study,indocyanine green galactography was performed on 44 pathological breasts.Among them,ICG fluorescence of 30 were detected through the breast skin,includes 14 cases with dot fluorescence imaging,7 cases with linear fluorescence imaging,and 9 cases with segmental fluorescence imaging.ICG fluorescence of 12 pathological breasts were detected within the skin incision,includes 10 cases with single duct fluorescence imaging and 2 cases with multiple ducts fluorescence imaging.Fluorescence imaging of subcutaneous lymphatic system was detected in 2 cases.2.In the study,the pathological glands where the pathological ducts located of 42 breasts were clearly marked within the surgical incision with ICG fluorescence.Indocyanine green can specifically dye pathological ducts green,and completely replace the function of methylene blue.3.Among 19 pathological breasts whose conventional galactography showed"trunk sign",ICG fluorescence of 12 showed fluorescence interruption and 2 showed fluorescence defect.Fluorescence interruption and fluorescence defect of ICG fluorescence were indicative of intraductal lesions.4.There were 25 pathological breasts with "tree sign" in the conventional galactography,and ICG fluorescence of 21 were detected through the breast skin.Among the 19 pathological breasts with "trunk sign" in conventional galactography,ICG fluorescence of 9 were detected through the breast skin.There is a statistical difference between the fluorescence imaging of "trunk sign" and "tree sign".5.Among the 31 pathological breasts with benign lesions diagnosed by pathological examination,ICG fluorescence of 21 were detected through the breast skin.Among 6 pathological breasts with borderline lesions,ICG fluorescence of 5 were detected through the breast skin.Among 7 pathological breasts with malignant lesions,ICG fluorescence of 4 were detected through the breast skin.There is no statistical difference in the fluorescence imaging of different pathological diagnosis.6.There were 32 pathological breasts of patients whose onset age are 21-50,among them,ICG fluorescence of 26 were detected through the breast skin.There were 12 pathological breasts of patients whose onset age are 51-70 and ICG fluorescence of 5 were detected through the breast skin.There is a statistical difference in the fluorescence imaging of two age groups.7.Among the 44 pathological breasts,there were 9 in the extremely dense type,22 in the heterogeneously dense type,10 in the scattered fibroglandular density type and 3 in fatty type.The average age of the four types increased linearly.With the decrease in the proportion of fibroglandular tissue and the increase in the proportion of adipose tissue,the proportion of ICG fluorescence imaging through the breast skin decreased.8.The pathological ducts of 8 breasts were located in the outer upper quadrant of the breasts,the ducts of 9 were in the outer lower quadrant,the ducts of 10 were in the inner upper quadrant,the ducts of 12 were in the inner lower quadrant,and 5 were in the central region of breasts.There is no statistical difference in the fluorescence imaging of the mammary ducts from four quadrants and central region.9.The average diameter of mammary ducts in 28 pathological breasts whose the ICG fluorescence imaging through the breast skin was 0.291cm,the same as the average diameter of ducts in 9 cases whose the ICG fluorescence imaging within the skin incision.There is no statistical difference in the average duct diameters of ICG fluorescence performances.10.The average distance from ducts to the skin in 28 pathological breasts whose the ICG fluorescence imaging through the breast skin was 1.745cm.The average distance from ducts to the skin in 9 pathological breasts whose the ICG fluorescence imaging within the skin incision was 2.316cm.There is a significant difference in the average distance of different ICG fluorescence performances.Conclusions1.The fluorescence of most patients’pathological ducts can be detected through the breast skin developed by ICG galactography,which is conducive to the locating of pathological ducts and the selection of surgical incision.2.The ICG fluorescence can be used to mark the breast segment where the pathological ducts located within the surgical incision.That is conducive to the accurate resection of the pathological glands.3.Indocyanine green is a green dye which can dye the galactophore green visually instead of the tracer function of methylene blue.4.The fluorescence performances of ICG galactography are surly related to the onset age of patients,the signs of conventional galactography,the depth of the ducts under the skin.5.The fluorescence performances of ICG galactography are unrelated to the pathological diagnosis,breast quadrant and diameter of the mammary duct.6.Indocyanine green galactography is a safe,effective and simple method,which has application value in the surgery of nipple discharge. |
