Muraoka Atsushi, Kobayashi Masahiko
Department of Surgery, Kagawa Rosai Hospital, Kagawa, Japan.
Ann Med Surg (Lond). 2022 Jun 7;79:103965. doi: 10.1016/j.amsu.2022.103965. eCollection 2022 Jul.
and importance: Tumor localization is vital in the surgical management of nonpalpable breast cancer. Various localization methods exist, each with their own disadvantages. Therefore, we need to investigate the optimal method of diagnosis for this condition.
A 66-year-old woman presented to our facility with a microcalcification detected on screening mammography (MMG). The lesion was neither palpable nor detectable on ultrasonography (US). Three-dimensional stereotactic biopsy using MMG revealed ductal carcinoma in situ. The precise tumor location was needed to perform breast-conserving surgery.
Our hospital did not have radioisotope imaging; hence, wire placement would have been difficult for this lesion location. To aid in localization, indocyanine green (ICG) and fluorescence imaging were used. ICG was injected preoperatively using stereotactic MMG, which enabled clear visualization of the lesion. Then, an accurate resection was performed. The patient was discharged without any complications 2 days after surgery.
The findings of this case report suggest that stereotactic MMG-guided ICG can be useful in localizing breast cancer tumors that are nonpalpable and undetectable by US.
及重要性：肿瘤定位在不可触及的乳腺癌手术治疗中至关重要。存在多种定位方法，每种方法都有其自身的缺点。因此，我们需要研究针对这种情况的最佳诊断方法。
一名66岁女性因在乳腺钼靶筛查（MMG）中发现微钙化而前来我院就诊。该病变在超声检查（US）中既不可触及也无法检测到。使用MMG进行的三维立体定向活检显示为原位导管癌。进行保乳手术需要精确的肿瘤定位。
我院没有放射性同位素成像；因此，对于该病变位置放置导丝会很困难。为了辅助定位，使用了吲哚菁绿（ICG）和荧光成像。术前使用立体定向MMG注射ICG，这使得能够清晰地观察到病变。然后，进行了精确切除。患者术后2天无任何并发症出院。
本病例报告的结果表明，立体定向MMG引导下的ICG可用于定位不可触及且US无法检测到的乳腺癌肿瘤。
