Excision of Nonpalpable Breast Cancer with Indocyanine Green Fluorescence-Guided Occult Lesion Localization (IFOLL)

Abstract

Background: Currently employed techniques for the localization of nonpalpable breast lesions suffer from various limitations. In this paper, we report on 2 patients in order to introduce an alternative technique, indocyanine green fluorescence-guided occult lesion localization (IFOLL), and determine its applicability for the surgical removal of this type of breast lesions. Case Reports: Preoperatively, one of the patients had a needle biopsyproven diagnosis of breast cancer, and the other one had suspicious findings for malignancy. Lesion localization was performed within 1 h before surgery under ultrasonography control by injecting 2 ml and 0.2 ml of indocyanine green into the lesion and its subcutaneous tissue projection, respectively. During surgery, the site of skin incision and the resection margins were identified by observing the area of indocyanine-derived fluorescence under the guidance of a near-infrared-sensitive camera. In both cases, the breast lesion was correctly localized, and the area of fluorescence corresponded well to the site of the lesions. Subsequent surgical excision was successful with no complications. On histopathologic examination, the surgical margins were found to be clear. Conclusion: IFOLL seems to be a technically applicable and clinically acceptable procedure for the removal of nonpalpable breast cancer.

Indocyanine green fluorescence-guided lumpectomy of nonpalpable breast cancer versus wire-guided excision: A randomized clinical trial

“…There are theoretical and practical advantages about the fluorescence navigation technique as a guidance to the surgical excision of NBCs. The first report about ICG‐guided localization was described in 2012 by Aydogan and associates, who used the technique as a guidance for the excision of NBCs in two cases, and had achieved clear margins. We also used the same method for the excision of NBCs in 56 patients and presented reviews of our experience.…”

“…With the aid of developing technology, a novel method of using fluorescence imaging of indocyanine green (ICG) has been described . To date, only two reports have been described about it utilized as an adjunct to the excision of nonpalpable breast lesions …”

Comparison of the value of superficial mark guided localization and hook‐wire guided localization techniques for non‐palpable breast microcalcifications: A retrospective clinical research

“…Many methods can be used for the localization of lesions. For example, WGL and SGL techniques, carbon black powder, ultrasound‐guided localization, the ROLL technique, the use of radioactive seeds, dye injection, the use of hydrogel‐encapsulated clips, localization with SAVI SCOUT and indocyanine green fluorescence‐guided occult lesion localization (IFOLL) …”

Patent blue and air as an alternative for resection of nonpalpable breast lesions: a case series

“…5 Nowadays, the majority of breast surgery services use ROLL as the standard procedure. In a literature review conducted by the authors of the present study, only nine studies used dye for localization of nonpalpable breast lesions.…”

“…In a literature review conducted by the authors of the present study, only nine studies used dye for localization of nonpalpable breast lesions. [3][4][5][6][7][8][9][10][11] Among these studies, two used a dye in association with ROLL 6,7 and one used a dye in association with a metal wire. 8 Of these nine, only two studies were Brazilian.…”