Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy

Ramos, Manuel; Díez, José Manuel Olivares; Ramos, T.; Ruano, Ricardo; Sancho, M.; González-Orús, J.M.

doi:10.1016/j.ijsu.2014.04.003

Cited by 32 publications

(21 citation statements)

References 29 publications

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“…In concordance with our study, Chan et al [18] and Sharek et al [19] stated that the most widely adopted [20], reported that wire-guided localization is the standard procedure but is a timeconsuming procedure because it requires the expertise of an experienced radiologist and it is uncomfortable and usually stressful for the patient. Moreover, it may be associated with a high number of positive margins, increases in local recurrences, inadvertent wire displacement during patient transfer, surgical positioning, or during postprocedure mammography and a poor cosmetic result while intraoperative ultrasound (IOUS) excision, an attractive and recommendable practice as an alternative to other excision techniques in patients with complete clinical responses after NACT as wire localization.…”

Section: Discussionsupporting

confidence: 92%

Clip and wire localization of locally advanced malignant breast masses in patients undergoing neoadjuvant chemotherapy and breast conservation therapy

Shalaby

Khallaf

Moussa

2019

Egypt J Radiol Nucl Med

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Background: In locally advanced breast cancers, the use of preoperative systemic therapy has been shown to induce tumor response and to improve the local control rate after subsequent surgery and radiation therapy. The purpose of the study is to evaluate the accuracy of localization of breast malignant masses in patients who received neoadjuvant chemotherapy and will undergo conservative breast surgery by using clip and wire marker. Results: Clip placement was done in 20/20 cases (100%). There was no mammographic evidence of clip migration or complication related to the clip insertion. Wire localization of tumor bed marked by radiopaque clip 1-day preoperative was done in 18/20 patient (90%), the other 2 patients, the masses were clinically palpable (10%). Accurate localization by wire was positive in 18/18 cases. Clip and wire retrieval were positive in all cases. Conclusion: Clip markers can be used for tumor localization in breast cancer patients undergoing neoadjuvant chemotherapy without migration. Clips are tolerated and safe for the patient, easily visualized on imaging, do not interfere with treatment response, and are cost-effective. Also, serves as a guide for post-neoadjuvant chemotherapy localization when the tumor is not palpable.

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Section: Discussionsupporting

confidence: 92%

Clip and wire localization of locally advanced malignant breast masses in patients undergoing neoadjuvant chemotherapy and breast conservation therapy

Shalaby

Khallaf

Moussa

2019

Egypt J Radiol Nucl Med

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“…The same is true for patients with tumors that are clipped with ultrasound guidance before neoadjuvant chemotherapy who subsequently have a complete radiologic response. The advantages of sonographically detectable clips in postneoadjuvant breast‐conserving surgery were recently shown by Ramos et al When a lesion is detectable solely by MRI, sonographically detectable clip deployment can again simplify subsequent localization. Postneoadjuvant localization in the situation of a residual tumor that is not adjacent to the clip may be especially problematic and should be preoperatively performed by the radiologist.…”

Section: Discussionmentioning

confidence: 96%

Detectability of Hygroscopic Clips Used in Breast Cancer Surgery

Carmon

Olsha

Gekhtman

et al. 2016

J of Ultrasound Medicine

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Sonographically detectable clips were introduced over the last decade. We retrospectively studied the rate and duration of sonographically detectable clip detectability in patients with breast cancer who had sonographically detectable clips inserted over a 2-year period. Nine of 26 patients had neoadjuvant chemotherapy, with all clips remaining detectable 140 to 187 days after insertion. Six of the 9 had intraoperative sonographic localization, with 1 reoperation (17%). Eleven additional patients with nonpalpable tumors and sonographically detectable clips had intraoperative sonographic localization with 1 reoperation (9%). In 1 patient, a sonographically detectable clip enabled intraoperative identification of a suspicious lymph node. There were no complications or clip migration. Sonographically detectable clips are helpful in breast cancer surgery with and without neoadjuvant chemotherapy, remaining detectable for many months and often averting preoperative localization and scheduling difficulties.

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“…Esta técnica también se ha demostrado de utilidad como método de exéresis en aquellas pacientes a las que se les había administrado quimioterapia neoadyuvante y presentaban LNP o, incluso, respuesta completa de la enfermedad, sólo persistiendo el marcador metálico colocado previo a la administración de la quimioterapia. La tasa de reintervenciones publicadas por márgenes afectos ha sido del 6,6% evitando en un 8,6% la reintervención de estas pacientes cuando se realizaba conjuntamente el estudio de los márgenes con la eco y el estudio intraoperatorio por el patólogo 43 . En general, la tasa de afectación de márgenes publicados con esta técnica varía desde un 0% descrito por Paramo hasta el 9% publicado por otros autores, con un valor predictivo negativo para la afectación de estos márgenes de un 92,8% [44][45][46][47][48] .…”

Section: Discussionunclassified

Útilidad de la ecografía intraoperatoria en la exéresis de las lesiones no palpables de la mama. Experiencia y revisión de conjunto

Fez¹,

Calero²,

Lerma

et al. 2019

Rev. chil. obstet. ginecol.

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RESUMENOBJETIVO: Presentar la experiencia de la unidad de mama de nuestro hospital con la utilización de la ecografía intraoperatoria en el tratamiento de las lesiones no palpables de mama. PACIENTES Y MÉTODO: Se incluyeron aquellas pacientes con lesiones no palpables de mama y ecovisibles. Intraoperatoriamente se localizó la lesión con la ecografía y se procedió a su exéresis, con comprobación ecográfica de su correcta extirpación con márgenes de seguridad. Se realizó estudio macroscópico en fresco de los márgenes marcados con tinta intraoperatoriamente. En caso de que los márgenes no fueran correctos se procedía a una ampliación de márgenes en el mismo acto quirúrgico. RESULTADOS: Desde el año 2012 se han intervenido 52 pacientes. En todas las pacientes se localizó la lesión con la ecografía. Se realizó tumorectomía a 24 pacientes y a 28 pacientes se les asoció la biopsia del ganglio centinela. El resultado patológico definitivo fue de 19 lesiones benignas y 33 lesiones malignas. A una paciente se le realizó mastectomía simple por presentar un carcinoma in situ extenso con microinfiltración no diagnosticado con las pruebas radiológicas preoperatorias. El resto de pacientes presentaron márgenes libres de tumor. CONCLUSIONES: La ecografía intraoperatoria es una técnica simple y fácil de desarrollar. Presenta una baja tasa de afectación de márgenes y es enteramente cirujano-controlada. Es confortable para el paciente y conlleva un bajo riesgo de complicaciones relacionadas con la técnica. PALABRAS CLAVE:Lesiones no palpables mama, ecografía intraoperatoria, cáncer de mama.ABSTRACT OBJETIVE: To present the results of our hospital's experience with the utilization of intraoperative ultrasound in the treatment of non-palpable breast lesions. PATIENTS AND METHOD: We included those patients whose breast lesions were non-palpable yet simultaneously visible on ultrasound. The lesions were located intraoperatively with ultrasound and were removed with ultrasound verification of the proper security margins. An examination of the intraoperative macroscopic margins with ink was done. In cases with incorrect margins, a re-excision was done utilizing the same technique but with amplified margins. RESULTS: Dating from 2012, we have operated on 52 patients. In all cases, the lesions were discovered and localized by means of ultrasound. Lumpectomy was performed on 24 patients and we associated the sentinel node biopsy in 28 cases. Subsequent pathology reports determined that 19 lesions were benign and 33 lesions

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Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy

Cited by 32 publications

References 29 publications

Clip and wire localization of locally advanced malignant breast masses in patients undergoing neoadjuvant chemotherapy and breast conservation therapy

Clip and wire localization of locally advanced malignant breast masses in patients undergoing neoadjuvant chemotherapy and breast conservation therapy

Detectability of Hygroscopic Clips Used in Breast Cancer Surgery

Útilidad de la ecografía intraoperatoria en la exéresis de las lesiones no palpables de la mama. Experiencia y revisión de conjunto

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