Effect of Introducing Hematoma Ultrasound-Guided Lumpectomy in a Surgical Practice

Abstract

BACKGROUND Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice. STUDY DESIGN Patients with nonpalpable lesions who underwent NL or HUG lumpectomy from January 2007 to December 2009 by a single surgeon were identified from a breast surgery database. Ease of scheduling, volume excised, re-excision rates, operating room time, and health care charges were the main outcomes variables. Univariate and multivariate analyses were performed to compare the 2 groups. RESULTS Lumpectomy was performed in 110 patients, 55 underwent HUG and 55 underwent NL. Hematoma ultrasound-guided lumpectomy was associated with a nearly 3-fold increase in the odds ratio of additional tissue being submitted to pathology (p = 0.039), but neither the total amount of breast tissue removed, nor the need for second procedure were statistically different between the 2 groups. Duration of the surgical procedure did not vary between the 2 groups; however, the time from biopsy to surgery was shorter for HUG by an expected 9.7 days (p = 0.019), implying greater ease of scheduling. Mean charges averaged $250 less for HUG than for NL, but this difference was not statistically significant. CONCLUSIONS Hematoma ultrasound-guided is equivalent to NL with regard to volume of tissue excised, need for operative re-excision, and operating room time. Adoption of HUG in our practice allowed for more timely surgical care.

Surgical treatment of nonpalpable primary invasive and in situ breast cancer

“…The authors reported, however, that a significantly greater number of intraoperative re-excisions were performed during primary surgery with HUG than with WGL (P = 0.04), resulting in additional tissue being sent to pathology; 90 nevertheless, no significant difference in overall tissue-volume excised (P = 0.57) was observed, and the impact of additional intraoperative re-excisions on cosmetic outcome was not addressed. 90 No other difference was reported between the two techniques. This modification of IOUS demonstrates potential benefits of ultrasonography, but requires assessment within prospective, randomized trials to exclude the inherent limitations of the performed retrospective studies.…”

“…The largest study by Arentz et al 89 90 identified a reduction in time-to-theatre in patients undergoing HUG, probably because this technique avoids the need for an additional radiology appointment and HUG was associated with lower costs ($250 cheaper) than WGL. The authors reported, however, that a significantly greater number of intraoperative re-excisions were performed during primary surgery with HUG than with WGL (P = 0.04), resulting in additional tissue being sent to pathology; 90 nevertheless, no significant difference in overall tissue-volume excised (P = 0.57) was observed, and the impact of additional intraoperative re-excisions on cosmetic outcome was not addressed.…”

Comparison of the value of superficial mark guided localization and hook‐wire guided localization techniques for non‐palpable breast microcalcifications: A retrospective clinical research

“…Many methods can be used for the localization of lesions. For example, WGL and SGL techniques, carbon black powder, ultrasound‐guided localization, the ROLL technique, the use of radioactive seeds, dye injection, the use of hydrogel‐encapsulated clips, localization with SAVI SCOUT and indocyanine green fluorescence‐guided occult lesion localization (IFOLL) …”

Intra‐operative guidance: Methods for achieving negative margins in breast conserving surgery

“…If the lesion has been excised via vacuum‐assisted biopsy then the post‐biopsy hematoma may be used to guide excision. Limitations of the technique include the learning curve of US operators' skills and the timing of surgery within 4 weeks to avoid resorption of hematoma.This technique has been demonstrated to achieve negative margins of resection equivalent to wire‐guided localization with a significantly smaller resection volume .…”