BackgroundNear infrared fluorescence imaging with Indocyanine Green (ICG) is now used for the imaging of lymph nodes and lymphatic vessels. In this work, we investigated the impact of its pre-operative and peri-operative administration on our ability to detect axillary lymphatic loss after breast cancer surgery.MethodsOne subcutaneous injection of ICG was administered in the ipsilateral hand of 109 women who were scheduled to have either a mastectomy with total axillary lymph node dissection (CALND) or a lumpectomy with selective lymphadenectomy (SLN) the day before (n = 53) or the same day of surgery (n = 56). The lymph leakages were assessed by means of the application of a compress in the operated armpit and by the presence or absence of fluorescence on it, as well as in the post-operative axillary drains.ResultsThe compress was fluorescent in 28% of SLN patients and 71% of CALND patients. The liquids in the axillary drains were also fluorescent in 71% of patients with CALND. No statistical significance was observed between the ICG injection groups. The association between compressive fluorescent and the presence of fluorescence in the axillary drains is significant in the pre-operative subgroup and in the whole group.ConclusionOur research demonstrates that lymphatic leaks aid in the development of seromas and calls into question the effectiveness of the ligatures and/or cauterizations used during surgery. A prospective, multicentric, randomized trial should be conducted to verify the efficacy of this approach.
Myofibroblastoma (MFB), also known as a solitary fibrous tumor of the breast, is a rare sporadic benign tumor composed of spindle-shaped tumor cells with myoblast differentiation. The most typical presentation is a painless unilateral mass that is not connected to any surrounding structure and seldom surpasses 3 cm in size and should be evaluated by using the triple-assessment approach. They have several subtypes, and a definite diagnosis can only be confirmed safely after surgery using immunohistochemistry. Surgical excision serves an essential diagnostic and therapeutic purpose; MFB has a favorable prognosis even when excision margins are positive, and local recurrence is extremely rare. The following is the case of a 73-year-old man who presented with a dry cough. An MFB was discovered by chance during the investigative workup and referred to our department. The patient’s presentation, imaging, and histological samples all supported the diagnosis, and he had surgical resection without incident. We present the second case of an incidental finding of breast MFB and urge clinicians to consider this differential diagnosis.
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