Intraoperative Ultrasound Can Decrease the Re-excision Lumpectomy Rate in Patients with Palpable Breast Cancers

Abstract

Positive margins occur in 15 to 69 per cent of patients undergoing lumpectomy. The current study was performed to evaluate intraoperative ultrasound in patients undergoing lumpectomy for palpable breast cancer. A retrospective chart review was performed of patients with palpable cancer who underwent lumpectomy with intraoperative ultrasound from 2004 to 2009. Each patient was matched with two patients who underwent lumpectomy alone over the same time period. Matching criteria included tumor size, clinical stage, body mass index, age at diagnosis, and lymphovascular invasion or extensive intraductal component. Twenty-two consecutive patients who underwent lumpectomy with intraoperative ultrasound were matched with 44 patients who underwent lumpectomy without intraoperative ultrasound. In addition to matching criteria, the patients were similar with respect to ethnicity, insurance status, weight, predominant histology, estrogen receptor, progesterone receptor, and Her2 status. Patients who underwent lumpectomy with intraoperative ultrasound were significantly less likely to have an involved margin (41 vs 9%, P = 0.01) and less likely to require a re-excision (34 vs 9%, P = 0.04). The lumpectomy volumes in the intraoperative ultrasound group were smaller than the volumes in the lumpectomy alone group. Intraoperative ultrasound can decrease the rate of positive margins and re-excision lumpectomy in patients with palpable breast cancers.

Ultrasonography-Guided Breast-Conserving Surgery Is Superior to Palpation-Guided Surgery for Palpable Breast Cancer

“…12,[20][21][22] Although the use of US-guided localization has not always been associated with better results, 20 most studies have demonstrated its superiority to palpation-guided tumorectomy regarding surgical margins and re-excision rates. 19,21,22 In agreement with this finding, we found that US-guided tumor excision was associated with a reduced rate of second operations. The excision volume was not significantly larger than the median excision volume in the palpation-guided group and was comparable with that of other reports.…”

“…18 Several groups have since tested the feasibility and security of the method for the localization of nonpalpable breast cancers and compared it with the standard radio-guided and wireguided localization techniques. 12,[19][20][21][22][23][24][25] These studies demonstrated the superiority of US-guided localization with regard to obtaining clear surgical margins. Furthermore, intraoperative US could facilitate wire-guided lumpectomy, leading to lower rates of positive margins (26).…”

“…The statistical calculations were performed using SPSS version 19.0 (SPSS, Chicago, IL). The Fisher exact test or c 2 tests were used to compare the different pathologic variables between the 2 groups.…”

“…Most series included only a small number of patients, and the benefits of US-guided BCS thus remain controversial. 12,[19][20][21][22][23][24][25] Our goal was to compare the rates of positive resection margins and re-excisions between standard palpation-guided tumor excision and US-guided surgery in a large cohort of breast cancer patients.…”

Ultrasound-Assisted Tumor Surgery in Breast Cancer – A Prospective, Randomized, Single-Center Study (MAC 001)

“…Other studies that have used ultrasound to mark tumor boundaries on the skin have also shown ▶ Table 4 Overview of the tumor-free margin distance and residual tumor burden in patients for whom reoperation was recommended. a reduction in R1 status [19,21]. We favor immediate intraoperative visualization.…”