Scholarlink

Background <p>Accurate margin assessment remains a challenge in breast-conserving surgery, where inaccuracy leads to excessive removal and compromised aesthetics. Although second near-infrared (NIR-II) fluorescence imaging offers high contrast, there is still a lack of clinically viable NIR-II equipment.</p> Methods <p>We develop an innovative NIR-II fluorescence navigation platform based on indocyanine green (ICG) that enables rapid deployment, operation-friendly workflow, and precision-at-hand capability for intraoperative guidance. Thirty-seven patients were recruited with 1&#xa0;mg/kg ICG injection 45&#xa0;minutes before surgery. Image quality was evaluated using perception-based image quality evaluator (PIQE) score, while quantitative analyses of fluorescence, including tumor-to-normal tissue ratio (TNR) and signal-to-background ratio (SBR), together with histopathology and a multi-level reader study, were performed to assess tumor contrast and diagnostic performance.</p> Results <p>Compared to conventional NIR-I imaging, our NIR-II system demonstrates performance with enhanced spatial resolution and a higher tumor-to-normal tissue ratio (4.383 ± 1.719 versus 3.154 ± 1.072, <i>P</i> &lt; 0.0001) in 37 patients. The intraoperative NIR-II imaging demonstrates superior tumor detection sensitivity [90.63% (75.78%-96.76%) vs. 84.38% (68.25%-93.14%)], with 100% diagnostic accuracy in delineating malignant tumor margins. Ex vivo NIR-II imaging enables real-time, precise visualization of tumor margins and suggested its potential to reduce the volume of excision. (NIR-II–defined volume &lt; NIR-I–defined volume &lt; current resection volume). Through brief training, surgeons can effectively utilize NIR-II imaging, shortening the learning curve for young surgeons in tumor and margin assessment.</p> Conclusion <p>This study demonstrates a clinically adaptable NIR-II imaging platform that expands intraoperative visualization without changing surgical workflow or adding operational burden, supporting standardized margin assessment and improved tissue preservation in breast surgery.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Intraoperative NIR-II fluorescence guidance for precise tumor margin assessment and maximized tissue preservation in breast surgery

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月30日

查看全文
  • Yiyin Zhang,
  • Ke Li,
  • Shuwei Zhang,
  • Houpu Yang,
  • Hailu Wang,
  • Yiting Chen,
  • Yenan Feng,
  • Dingbao Chen,
  • Zeyu Zhang,
  • Shu Wang

摘要

Background

Accurate margin assessment remains a challenge in breast-conserving surgery, where inaccuracy leads to excessive removal and compromised aesthetics. Although second near-infrared (NIR-II) fluorescence imaging offers high contrast, there is still a lack of clinically viable NIR-II equipment.

Methods

We develop an innovative NIR-II fluorescence navigation platform based on indocyanine green (ICG) that enables rapid deployment, operation-friendly workflow, and precision-at-hand capability for intraoperative guidance. Thirty-seven patients were recruited with 1 mg/kg ICG injection 45 minutes before surgery. Image quality was evaluated using perception-based image quality evaluator (PIQE) score, while quantitative analyses of fluorescence, including tumor-to-normal tissue ratio (TNR) and signal-to-background ratio (SBR), together with histopathology and a multi-level reader study, were performed to assess tumor contrast and diagnostic performance.

Results

Compared to conventional NIR-I imaging, our NIR-II system demonstrates performance with enhanced spatial resolution and a higher tumor-to-normal tissue ratio (4.383 ± 1.719 versus 3.154 ± 1.072, P < 0.0001) in 37 patients. The intraoperative NIR-II imaging demonstrates superior tumor detection sensitivity [90.63% (75.78%-96.76%) vs. 84.38% (68.25%-93.14%)], with 100% diagnostic accuracy in delineating malignant tumor margins. Ex vivo NIR-II imaging enables real-time, precise visualization of tumor margins and suggested its potential to reduce the volume of excision. (NIR-II–defined volume < NIR-I–defined volume < current resection volume). Through brief training, surgeons can effectively utilize NIR-II imaging, shortening the learning curve for young surgeons in tumor and margin assessment.

Conclusion

This study demonstrates a clinically adaptable NIR-II imaging platform that expands intraoperative visualization without changing surgical workflow or adding operational burden, supporting standardized margin assessment and improved tissue preservation in breast surgery.