A decade of intraoperative ultrasound guided breast conservation for margin negative resection – Radioactive, and magnetic, and Infrared Oh My…

Rahman, Rakhshanda Layeequr; Puckett, Yana; Habrawi, Zaina; Crawford, Sybil L.

doi:10.1016/j.amjsurg.2020.09.008

Cited by 7 publications

(4 citation statements)

References 42 publications

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“…Also, preoperative microwave ablation is reported to be another technique which could guide BCS with better result of resection margin and without impairing sentinel lymph node biopsy [10]. In the operation, tumor localization using intraoperative ultrasound can help attaining negative margins without removal of much healthy breast tissue [11][12][13]. Multiple radioactive seed is another means for tumor localization with good result of negative resection margin [14].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Frozen Section Margin Positive in Breast-Conserving Surgery; Current Status and Ways to Reduce It.

LEE

Yoo

et al. 2023

Preprint

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Purpose There have been many analyzes of permanent resection margin (PM) in breast conserving surgery (BCS) but few studies have organized the data of intraoperative frozen section margin (FM). We were aimed to focus more on FM and organize the data including FM. Methods A single center, retrospective study was conducted. The electronic medical records of the patients who underwent BCS for breast cancer between January 2015 and December 2015 in Asan Medical Center were reviewed. We investigated the rate of positive FM and the difference in operation time according to the result of FM. Also, we analyzed various patient and tumor related factors which can affect the result of resection margin (RM) including FM. Results 1,110 patients were included in the analysis. FM evaluation was done in 56.5% (627/1110). The rate of positive FM was 12.4% (78/627). The operation time was significantly longer when additional resection was done for positive FM (112.7 ± 32.6 min vs 74.7 ± 22.9 min, p < .001). By univariate analysis, multiplicity, non-mass enhancement (NME) on magnetic resonance imaging (MRI), maximum diameter on MRI, T3, N2-3, invasive lobular carcinoma (ILC), presence of extensive intraductal component (EIC) and presence of ductal carcinoma in situ (DCIS) were factors significantly associated with the result of RM while after multivariate analysis, multiplicity, ILC and presence of EIC showed statistical significance. Conclusions The operation time was significantly longer when additional resection was done for positive FM. Further data collection and organization is needed for standardized predictive tool for FM.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Frozen Section Margin Positive in Breast-Conserving Surgery; Current Status and Ways to Reduce It.

LEE

Yoo

et al. 2023

Preprint

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“…According to a study spanning ten years, involving 945 BCS patients, only 5% patients received margin revision owing to inadequate resection. And the routine margin assessment method was IOUS guided lumpectomy followed by ex vivo ultrasound (25). Numerous studies have unanimously demonstrated IOUS's excellence at achieving negative margins, lowering resection tissue volume and improving overall aesthetic result and patient-satisfaction (26)(27)(28).…”

Section: Conventional Imaging Methodsmentioning

confidence: 99%

Development of intraoperative assessment of margins in breast conserving surgery: a narrative review

Li¹,

Li²

2022

Gland Surg

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Objective: We intend to provide an informative and up-to-date summary on the topic of intraoperative assessment of margins in breast conserving surgery (BCS). Conventional methods as well as cutting-edge technologies are analyzed for their advantages and limitations in the hope that clinicians can turn to this for reference. This review can also offer guidance for technicians in the future design of intraoperative margin assessment tools.Background: Achieving negative margins during BCS is one of the vital factors for preventing local recurrence. Conducting intraoperative margin assessment can ensure negative margins to a large extent and possibly relieve patients of the anguish of re-interventions. In recent years, innovative methods for margin assessment during BCS are advancing rapidly. And there is a lack of summary regarding the development of intraoperative margin assessment in BCS.Methods: A PubMed search with keywords "intraoperative margin assessment" and "breast conserving surgery" was conducted. Relevant publications were screened manually for its title, abstract and even full text to determine its true relevance. Publications on neo-adjuvant therapy and intraoperative radiotherapy were excluded. References from the searched articles and other supplementary articles were also looked into.Conclusions: Conventional methods for margin assessment yields stable outcome but its use is limited because of the demand on pathology staff and the trade-off between time and precision. Conventional imaging techniques pass the workload to radiologists at the cost of a significantly low duration of time.Involving artificial intelligence for image-based assessment is a further improvement. However, conventional imaging is inherently flawed in that occult lesions can't show on the image and the showing ones are ambiguous and open to interpretation. Unconventional techniques which base their judgment on cellular composition are more reassuring. Nonetheless, unconventional techniques should be subjected to clinical trials before putting into practice. And studies regarding comparison between conventional methods and unconventional methods are also needed to evaluate their relative efficacy.

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“…Furthermore, negative margin rates reported in WGL-based studies including very heterogenous patient populations (invasive and in situ carcinoma with varying lesion sizes) are in the range of 62-93 % [6,7]. Therefore, attempts have been made to introduce new techniques, including intraoperative ultrasound (IOUS), radioactive seed localization (RSL), radioguided occult lesion localization (ROLL), magnetic seeds, radiofrequency identification tags (RFID), as well as radar reflector-based localization [8,9,10,11,12]. Importantly, the term IOUS should not be used interchangeably with specimen sonography, since IOUS refers to targeted dissection of tumor tissue with free margins using in vivo sonographic visualization, while specimen sonography is an imaging procedure of a specimen outside the human body.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Ultrasound-Guided Excision of Non-Palpable and Palpable Breast Cancer: Systematic Review and Meta-Analysis

et al. 2022

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Wire-guided localization (WGL) is the most frequently used localization technique in non-palpable breast cancer (BC). However, low negative margin rates, patient discomfort, and the possibility of wire dislocation have been discussed as potential disadvantages, and re-operation due to positive margins may increase relapse risk. Intraoperative ultrasound (IOUS)-guided excision allows direct visualization of the lesion and the resection volume and reduces positive margins in palpable and non-palpable tumors. We performed a systematic review on IOUS in breast cancer and 2 meta-analyses of randomized clinical trials (RCTs). In non-palpable BC, 3 RCTs have shown higher negative margin rates in the IOUS arm compared to WGL. Meta-analysis confirmed a significant difference between IOUS and WGL in terms of positive margins favoring IOUS (risk ratio 4.34, p < 0.0001, I2 = 0%). 41 cohort studies including 3291 patients were identified, of which most reported higher negative margin and lower re-operation rates if IOUS was used. In palpable BC, IOUS was compared to palpation-guided excision in 3 RCTs. Meta-analysis showed significantly higher rates of positive margins in the palpation arm (risk ratio 2.84, p = 0.0047, I2 = 0%). In 13 cohort studies including 942 patients with palpable BC, negative margin rates were higher if IOUS was used, and tissue volumes were higher in palpation-guided cohorts in most studies. IOUS is a safe noninvasive technique for the localization of sonographically visible tumors that significantly improves margin rates in palpable and non-palpable BC. Surgeons should be encouraged to acquire ultrasound skills and participate in breast ultrasound training.

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A decade of intraoperative ultrasound guided breast conservation for margin negative resection – Radioactive, and magnetic, and Infrared Oh My…

Cited by 7 publications

References 42 publications

Intraoperative Frozen Section Margin Positive in Breast-Conserving Surgery; Current Status and Ways to Reduce It.

Intraoperative Frozen Section Margin Positive in Breast-Conserving Surgery; Current Status and Ways to Reduce It.

Development of intraoperative assessment of margins in breast conserving surgery: a narrative review

Intraoperative Ultrasound-Guided Excision of Non-Palpable and Palpable Breast Cancer: Systematic Review and Meta-Analysis

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