L-ICG as an optical agent to improve intraoperative margin detection in breast-conserving surgery: a prospective study.

Summary

In a prospective cohort (n=54), local injection of L-ICG enabled fluorescence-guided BCS with low final positive margin rate (1.9%), wide margins, excellent cosmetic satisfaction, and no serious adverse events over a median 12.8-month follow-up. This technique may reduce re-excisions while preserving cosmetic outcomes.

Key Findings

• Final positive margin rate was 1.9% after intraoperative management (initial intraoperative positive margin 9.3%).
• Median margin widths were 8 mm (cranial), 5.5 mm (caudal), 6 mm (medial), and 8 mm (lateral).
• Cosmetic outcomes were highly favorable: 100% somewhat/very satisfied when clothed; 98% rated Good/Excellent appearance; no serious adverse events and no relapses at median 12.8 months.

Clinical Implications

Surgeons may consider incorporating L-ICG-based FIGS to improve intraoperative margin assessment, potentially reducing re-excision rates while optimizing patient-reported cosmetic outcomes.

Limitations

• Single-arm, single-center study without a randomized comparator; potential selection bias.
• Short to mid-term follow-up; oncologic durability and generalizability remain to be established.

Future Directions

Conduct multicenter randomized trials comparing L-ICG FIGS vs standard care on re-excision, local control, cosmesis, and cost-effectiveness; optimize dosing/timing and imaging protocols.