Qiu Zi-Xuan, Xie Li-Yun, Li Ying-Zi, Zhang Ze-Chun, Chen Hai-Lu, Zhan Wan-Lin, Huang Qin, Huang Jian-Hao, Wu Zhi-Yong, Qiu Si-Qi
Diagnosis and Treatment Center of Breast Diseases, Shantou Central Hospital, Waima Road 114, Jinping District, Shantou, 515041, China.
Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
Breast Cancer Res Treat. 2025 Apr;210(3):709-718. doi: 10.1007/s10549-025-07609-6. Epub 2025 Jan 20.
Precise tumor excision is important in breast-conserving surgery (BCS). This study explores the safety and accuracy of fluorescence image-guided BCS (FIGS) using a lidocaine mucilage-ICG compound (L-ICG).
54 patients who underwent BCS from August 2020 to September 2023 were enrolled. L-ICG was locally injected 0.5 cm from the tumor border. FIGS was performed to guide the tumor excision. Frozen sectioning of surgical field biopsies was used to assess the intraoperative margin status. The primary outcome measures were margin width and positive margin rates. Cosmetic outcome was evaluated by the modified version of Breast-QTM Breast-Conserving Therapy Module (Postoperative) and breast cosmetic outcome assessment criteria.
The median cranial, caudal, medial, and lateral margin widths were 8 mm (interquartile range [IQR], 3-14), 5.5 mm (IQR, 2-15), 6 mm (IQR, 3-15), and 8 mm (IQR, 3-15), respectively. Five out of 54 (9.3%) patients had an intraoperative positive margin. Intraoperatively extended resection was performed for four patients and mastectomy for the remaining one. This further reduced the positive margin rate to 1.9% at final histopathology. 50 patients received cosmetic outcome evaluation, 100% of them were "somewhat satisfied" or "very satisfied" with the appearance of the operated breast when clothed and 98% of them were scaled as "Good" or "Excellent" in their appearance of the operated breast. No serious adverse events were observed. With a median follow-up of 12.8 months, no events for tumor relapse were observed.
L-ICG-based FIGS is a promising technique to guide precise tumor excision in BCS.
在保乳手术（BCS）中，精确的肿瘤切除至关重要。本研究探讨使用利多卡因黏液-吲哚菁绿复合物（L-ICG）的荧光图像引导保乳手术（FIGS）的安全性和准确性。
纳入2020年8月至2023年9月期间接受保乳手术的54例患者。在距肿瘤边界0.5厘米处局部注射L-ICG。进行荧光图像引导保乳手术以指导肿瘤切除。手术切缘活检的冰冻切片用于评估术中切缘状态。主要观察指标为切缘宽度和阳性切缘率。通过改良版的Breast-QTM保乳治疗模块（术后）和乳房美容效果评估标准评估美容效果。
头侧、尾侧、内侧和外侧切缘宽度的中位数分别为8毫米（四分位间距[IQR]，3 - 14）、5.5毫米（IQR，2 - 15）、6毫米（IQR，3 - 15）和8毫米（IQR，3 - 15）。54例患者中有5例（9.3%）术中切缘阳性。4例患者术中进行了扩大切除，其余1例行乳房切除术。最终病理检查时，这进一步将阳性切缘率降至1.9%。50例患者接受了美容效果评估，其中100%对穿着衣服时手术乳房的外观“有些满意”或“非常满意”，98%的患者手术乳房外观被评为“良好”或“优秀”。未观察到严重不良事件。中位随访12.8个月，未观察到肿瘤复发事件。
基于L-ICG的荧光图像引导保乳手术是一种有前景的技术，可指导保乳手术中精确的肿瘤切除。
