Application of near-infrared fluorescence imaging in the accurate assessment of surgical margins during breast-conserving surgery

Abstract

Objective To evaluate the feasibility and accuracy of near-infrared fluorescence imaging technology for assessing margins during breast-conserving surgery for breast cancer. Methods Forty-three breast cancer patients who received surgical treatment at Yijishan Hospital of Wannan Medical College were selected. Before the operation, the patients were administered with an indocyanine green injection of 0.5 mg/kg intravenously 2 h before operation. During and after the operation, all patients underwent surgical margin monitoring with the near-infrared fluorescence imaging system for fluorescence imaging and acquisition of images and quantitative fluorescence intensity. During the operation, the patients’ tissue specimens were collected on the upper, lower, inner, outer, apical, and basal sides of the fluorescence boundary of the isolated lesions for pathological examination. Results Fluorescence was detected in the primary tumor in all patients. The average fluorescence intensities of tumor tissue, peritumoral tissue, and normal tissue were 219.41 ± 32.81, 143.35 ± 17.37, and 105.77 ± 17.79 arbitrary units, respectively (P < 0.05, t test). The signal-to-background ratio of tumor to peritumor tissue and normal tissue was 1.54 ± 0.20 and 2.14 ± 0.60, respectively (P < 0.05, t test). Abnormal indocyanine green fluorescence was detected in 11.6% patients (5/43), including 3 patients with residual infiltrating carcinoma and 2 patients with adenosis with ductal dilatation. Conclusion This study confirms the high sensitivity and specificity of near-infrared fluorescence imaging technology for breast-conserving surgery margin assessment. Near-infrared fluorescence imaging technology can be used as an intraoperative diagnosis and treatment tool to accurately determine the surgical margin and is of important guiding value in breast-conserving surgery for breast cancer.

Efficacy of indocyanine green fluorescence for the identification of non-palpable breast tumours: systematic review

“…All included studies were published between 2012 and 2023 ( Table 1 ); they included five comparative studies (two RCTs 16 , 20 , one non-randomized three-arm clinical trial 24 , one cohort study with a historical control group 17 , and one retrospective study with a control group 22 ), three single-arm clinical trials 21 , 23 , 26 , one single-arm retrospective cohort study 18 , and two case reports 15 , 25 . One study was conducted across four medical centres 20 , another study involved two medical institutions 24 , and all others were single-centre studies.…”

“…Five studies received funding for their research project 17 , 20 , 21 , 24 , 26 . The funding sources had no role in collection, analysis and interpretation of the data, or submission of the manuscript.…”

“…Most studies (9 of 11) performed an ultrasound-guided ICG injection in the centre of the lesion or in the tumour resection surface. Two studies administered an intravenous ICG injection at 2 or 24 h before surgery at a dose of 5 mg/kg 23 , 26 . Table S3 lists the different camera systems used across the studies.…”

“… 25 , visualization of injected lesion; Tong and Guo 16 , retrieval of lesions as confirmed by imaging of breast specimens; and Wang et al . 26 , preoperative fluorescence detection of primary tumour. †Not reported.…”

Fluorescence imaging for real-time detection of breast cancer tumors using IV injection of indocyanine green with non-conventional imaging: a systematic review of preclinical and clinical studies of perioperative imaging technologies

“…FI has the potential to be a highly beneficial technique for real-time tumor identification and assessment of tumor boundaries during surgical procedures, particularly in BC. However, its clinical applications for tumor resection are currently limited, with only a few studies conducted in BC [ 4 , 10 , 26 , 33 , 34 , 42 , 43 ].…”