Comparison of intraoperative ultrasound‐guided excision and hookwire‐guided excision of impalpable breast lesions: An economic evaluation

Behrendorff, Natasha; Febery, Alice; Khoo, Jeremy F.; Bennett, Ian C.

doi:10.1111/tbj.13883

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…The IOUS technique is cost‐saving. A recent study comparing the financial outlays of the IOUS technique with the hookwire‐guided excision technique demonstrated IOUS to be economically advantageous 3 . Other methodologies including the use of radioactive seeds, magnetic seeds and radiofrequency devices involve considerable cost for expensive equipment.…”

Section: Discussionmentioning

confidence: 99%

“…2 The technique of IOUS-guided excision of impalpable breast lesions is straightforward, easily reproducible and inexpensive. [2][3][4] Senior author (IB) has previously published a series of 115 IOUS-guided excisions of impalpable breast lesions, where breast malignancies comprised 42% of all excised lesions. Of these, adequate margins of excision were achieved at the first operation in 93% of cases.…”

Section: Introductionmentioning

confidence: 99%

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Technique of intraoperative ultrasound‐guided excision of impalpable breast lesions

Khoo

Wong

Stephenson

et al. 2022

Australas J Ultrason Med

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The introduction of breast screening programs has led to the increased detection of occult breast lesions requiring diagnostic surgical biopsy or breast‐conserving surgery for early‐stage breast cancer. Excision of impalpable breast lesions can be challenging. Whilst a variety of techniques have now been described including the use of adjuncts such as hook wires, radioactive seeds, magnetic seeds or radiofrequency devices, many of these modalities are expensive and can be logistically problematic. The technique of surgeon‐performed ultrasound‐guided excision is a straightforward technique which is safe, cost‐efficient and avoids a painful preoperative procedure for patients such as hook wire localisation. Whilst the use of intraoperative ultrasound‐guided excision of breast lesions has been widely reported, the actual technique itself has been less well described.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Technique of intraoperative ultrasound‐guided excision of impalpable breast lesions

Khoo

Wong

Stephenson

et al. 2022

Australas J Ultrason Med

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“…Recently, Behrendorff et al performed a comparative cost analysis of WGL vs. IOUS-guided surgery in a large teaching hospital in Australia [29]. Only patients with non-palpable lesions receiving no axillary intervention were included.…”

Section: Which Localization Techniques Are Most Cost-effective?mentioning

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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“…Kürzlich haben Behrendorff et al eine vergleichende Kostenanalyse von WGL-geführter im Vergleich zu IOUS-geführter Chirurgie in einem großen Lehrkrankenhaus in Australien durchgeführt [29]. Es wurden nur Patientinnen mit nicht tastbaren Läsionen eingeschlossen, bei denen kein Eingriff an der Achselhöhle vorgenommen wurde.…”

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Intraoperative Sonografie zur Entfernung von nicht-palpablen und palpablen Mammakarzinomen: systematisches Review und Meta-Analyse

Banys‐Paluchowski

Rubio

Çakmak

et al. 2022

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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ZusammenfassungDrahtlokalisation stellt die am häufigsten verwendete Lokalisationsmethode bei nicht palpablen Mammakarzinomen dar. Zu potenziellen Nachteilen der Technik gehören eine niedrige Rate an R0-Resektionen, die Invasivität und das Risiko der Drahtdislokation. Des Weiteren ist die Notwendigkeit einer Re-Operation mit einem erhöhten Rezidivrisiko assoziiert. Intraoperative Sonografie (IOUS) erlaubt eine direkte Visualisierung der Läsion und des Resektionsvolumens und reduziert die Rate an positiven Rändern bei palpablen und nicht palpablen Tumoren. Wir führten ein systematisches Review der Studien zur IOUS durch. Die randomisierten Studien wurden in 2 Metaanalysen ausgewertet. In nicht palpablen Mammakarzinomen zeigten 3 randomisierte Studien höhere R0- Resektionsraten im IOUS-Arm, verglichen mit Drahtlokalisation. Der signifikante Unterschied konnte in der Metaanalyse bestätigt werden (Risk Ratio 4,34, p < 0,0001, I2 = 0 %). Die meisten der 41 Kohortenstudien mit 3291 Patientinnen zeigten höhere R0-Resektionsraten und niedrigere Nachresektionsraten bei Verwendung von IOUS. Eine Metaanalyse von 3 randomisierten Studien bei palpablem Mammakarzinom zeigte signifikant höhere Raten an positiven Rändern im Palpations-Arm (Risk Ratio 2,84, p=0,0047, I2=0%). In 13 Kohortenstudien mit 942 Patientinnen mit palpablem Mammakarzinom, waren die R0-Resektionsraten meist höher und die Gewebsvolumina niedriger bei Verwendung von IOUS. IOUS ist eine sichere nicht invasive Technik zur Lokalisation von sonografisch sichtbaren Tumoren und verbessert R0-Resektionsraten bei palpablem und nicht palpablem Mammakarzinom. Sonografische Weiterbildung für Brustoperateure erscheint empfehlenswert.

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Comparison of intraoperative ultrasound‐guided excision and hookwire‐guided excision of impalpable breast lesions: An economic evaluation

Cited by 3 publications

References 10 publications

Technique of intraoperative ultrasound‐guided excision of impalpable breast lesions

Technique of intraoperative ultrasound‐guided excision of impalpable breast lesions

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

Intraoperative Sonografie zur Entfernung von nicht-palpablen und palpablen Mammakarzinomen: systematisches Review und Meta-Analyse

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