Application Of Indocyanine Green Near Infrared Fluorescence Imaging In Breast Conserving Surgery

Objective: The purpose of this study is to explore the value of breast-conserving surgery guided by near-infrared fluorescence imaging and traditional breast-conserving surgery in normal tissue removal,cutting edge state,tumor resection time and postoperative breast aesthetic effect.To evaluate whether near-infrared fluorescence imaging is safe and feasible and has important guiding value in breast conserving surgery for breast cancer,as well as whether it has greater technical advantages compared with traditional breast-conserving surgery.Methods: The clinical data of 155 patients with breast cancer who received surgical treatment in Yijishan Hospital of Wannan Medical College from September 2020 to December 2022 were analyzed.Among them,55 patients underwent surgery with indocyanine green labeling under the guidance of near-infrared fluorescence imaging system(fluorescence group),and 100 patients underwent routine breast-conserving surgery(control group).The clinical characteristics and tissue samples were compared between the two groups To investigate whether indocyanine green near infrared fluorescence imaging technique has more advantages than the guidance of imaging examination in BCS,such as the size of the dose,the status of resection margin,the time of tumor resection,the diagnosis rate and the aesthetic effect after breast surgery.Results: Among the 155 cases of breast-conserving surgery,55 cases(35.48%)in the fluorescence group were guided by indocyanine green near-infrared fluorescence imaging,and 100 cases(64.52%)in the conventional group were treated with preoperative imaging examination and clinical experience of intraoperative surgeons.Both of these two guiding methods can locate and remove the lesions.However,the negative rate of the cutting edge of the lesions resected in the fluorescence group(96.36%)was significantly higher than that in the conventional group(81.00%),which reduced the possibility of re-resection.When considering the result of tissue specimen size,the volume of tumor specimen obtained by localized tumor resection in the fluorescence group was 8.25 ±3.39 cm ^ 3,while that in the conventional group was 11.34 ±3.95 cm ^ 3(P=0.002).The average tumor resection time in the fluorescence group was(13.85 ±3.39)min,which was faster than that in the control group(18.78 ±4.81)min(P < 0.05).Combined with the aesthetic effect of the breast after operation,51 cases(92.73%)in the fluorescent group had good aesthetic effect,and 4 cases(7.27%)had poor aesthetic effect,compared with 82 cases(82.00%)in the routine group and 18 cases(18.00%)in the conventional group(P < 0.05).Fluorescence was detected in all patients with primary tumors.The average fluorescence intensity of tumor tissue,peri-tumor tissue and normal tissue was 229.84 ±22.03,144.02 ±14.12 and 108.64±9.76 arbitrary units,respectively.The fluorescence signal background ratio of tumor to peri-tumor tissue and normal tissue was 1.60 ±0.17 and 2.13 ±0.25 respectively(P < 0.05).The sensitivity and specificity of near infrared fluorescence imaging in the evaluation of cutting edge of breast conserving surgery for breast cancer were 66.66% and 94.23%,respectively.Conclusion: Intraoperative application of near infrared fluorescence imaging technology for tumor localization can effectively avoid excessive excision of healthy tissue,and has high sensitivity and specificity for the assessment of the status of the resection margin,which can significantly reduce the positive rate of the first resection margin,ensure the postoperative appearance of the breast can obtain good aesthetic effect,and shorten the operation time.Near infrared fluorescence imaging technique is safe and feasible in breast conserving surgery and has important guiding value.