Intraoperative Indocyanine Green Fluorescence Imaging in Primary Breast Angiosarcoma: A Report of a Feasibility Case

Primary breast angiosarcoma (PBA) is a rare and aggressive malignancy for which no standardised intraoperative margin assessment tool currently exists, and complete surgical excision with negative margins represents the cornerstone of treatment.Near-infrared fluorescence imaging (NIR-FI) with indocyanine green (ICG) has emerged as a promising intraoperative tool for tumour visualisation and margin assessment in various solid tumours, but its application in PBA has not previously been described.To our knowledge, we report the first use of ICG-FI for real-time surgical margin evaluation in PBA in a 42year-old woman presenting with progressive right breast enlargement who was diagnosed with low-grade PBA following expert pathological review.After multidisciplinary discussion, radical mastectomy was performed; ICG (0.25 mg/kg) was administered intravenously at anaesthetic induction, and intraoperative ICG-FI was performed during flap dissection, after specimen removal, and following gross pathological sectioning.The tumour demonstrated clear and homogeneous fluorescence with a tumour-to-background ratio (TBR) of 3.7, enabling visual delineation from surrounding tissues.Final histopathological examination confirmed an 11-cm low-grade PBA completely excised with negative margins.The absence of residual fluorescence within the surgical bed and on the specimen margins correlated with histopathologically confirmed negative margins, and postoperative recovery was uneventful.This case report demonstrates the technical feasibility of intraoperative ICG-FI in PBA, providing real-time visual confirmation of the surgical field, without identifying additional margins or altering the planned surgical strategy.Within the IDEAL framework for surgical innovation, this proof-of-concept report supports further prospective evaluation in collaborative registries to define the potential role of ICG-FI in improving local control in this rare and surgically challenging malignancy.