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Abstract

Background: The aim of our study was to perform cryosurgery of a primary breast tumor en bloc coupled with simultaneous intratumoral injection of a blue dye to evaluate lymphatic mapping. We explored the ability of our strategy to prevent tumor cells, but not injected trac-ers, to migrate to the lymphovascular drainage during conventional resection of frozen breast tumors. Methods: Fourteen patients aged 50 ± 14 y (mean ± SD), presenting with stage II to IV breast cancer, were operated on from 2013 to 2015. Under intraoperative ultrasound (IOUS), 11 patients underwent cryo-assisted tumor injection and resection (CATIR), which consisted of tumor freezing en bloc and concomitant injection of the tumor with a blue dye before resection and sentinel lymph node dissection, and three patients had palliative in situ cryosurgical tumor injection and ablation (CATIA). Results: The IOUS facilitated needle positioning and dye injection timing. In the CATIR group, the frozen site extruded the dye that distributed in the unfrozen tumor, the breast tissue, and the resection cavity for 10 patients. One to four lymph nodes were stained from 7 of 10 patients. The resection margin was evaluable. Conclusions: Our IOUS-guided strategy revealed the injection and migration of a blue dye during the en bloc freezing and resection of breast tu-mors. Sentinel lymph node mapping and the pathological determination of the tumor and resection margins were achievable. Our study paves the way for intraoperative cryo-assisted therapeutic strategies for breast cancer.

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