Intraoperative ultrasound reduces the need for re-excision in breast-conserving surgery

Karanlık, Hasan; Özgür, İlker; Şahın, Dilek; Fayda, Merdan; Önder, Semen; Yavuz, Ekrem

doi:10.1186/s12957-015-0731-2

Cited by 33 publications

(26 citation statements)

References 35 publications

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“…Another study conduced by Karanlik H obtained adequate resection on 94 % of patients in the US-guided surgery group and on 83 % of patients in the palpation guided group (p=0.03). However, Olsha O. et al in a study on 45 patients conclude that intraoperative ultrasonography tends to overestimate the real margin width, reporting the sensitivity and specificity equal with 25% and 95%, respectively [ 22 , 23 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Obtaining Adequate Surgical Margin Status in Breast-Conservation Therapy: Intraoperative Ultrasound-Guided Resection Versus Specimen Mammography

Pop

Cristian

Hankó-Bauer

et al. 2018

Medicine and Pharmacy Reports

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Background and aimThe purpose of breast-conserving surgery (BCS) for women with cancer is to perform an oncological radical procedure with disease-free margins at the final histological assessment and with the best aesthetic result possible. Intraoperative resected specimen ultrasound and intraoperative resected specimen mammography may reduce the rates of positive margins and reexcision among patients undergoing conserving therapy. Our objective is to compare the two methods with the histopathological results for a preset cut off and asses which parameters can influence the positive margin status.MethodA prospective study was performed on 83 patients who underwent breast conservation surgery for early breast cancer (pT1-3a pN0-1 M0) between 2014 and 2016. After excision the specimen was oriented in the operating room by the surgeon. Metallic clips and threads were placed on margins: one clip and the long thread at 12 o’clock, two clips and the short threads at 9 o’clock. The next step was intraoperative ultrasound assessment of the specimen. For the margins under 2 mm we performed selective margin shaving, followed by mammography to identify and document the lesion and finally histopathological examination of the specimen with reporting the gross and microscopic margins. The positive margins required re-excision or boost of radiation at the posterior or anterior margins, depending on the case.ResultsWe set a cut-off at 2 mm. The sensitivity and specificity of the intraoperative margin assessment via the ultrasound method were 90.91% (95% CI 70.84–98.88%) and 67.21% (95% CI 54–78.69%) respectively. The sensitivity and specificity of the intraoperative margin assessment via the mammographic procedure were 45.45% (95% CI 24.39–67.79%) and 85.25% (95% CI 73.83–93.02%) respectively. There was positive correlation between the histopathological and intraoperative ultrasound exam (p=0.018) and negative correlation between the histopathological exam and the post-operative mammographic exam (p=0.68). We found a positive correlation between the positive margin status and age (<40), preoperative chemotherapy, intraductal carcinoma, inflammatory process around the tumor, and the immunohistochemical triple negative profile.ConclusionsAccording to our results, the intraoperative ultrasound of the breast specimen for a cutt-off at 2 mm can decrease the rates of margin positivity compared to the mammographic procedure and has the potential to diminish the number of subsequent undesired re-excisions.

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Section: Discussionmentioning

confidence: 99%

Obtaining Adequate Surgical Margin Status in Breast-Conservation Therapy: Intraoperative Ultrasound-Guided Resection Versus Specimen Mammography

Pop

Cristian

Hankó-Bauer

et al. 2018

Medicine and Pharmacy Reports

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“…Another intraoperative imaging modality for reducing rates of margin positivity at initial surgery is IOUS, which can be performed by surgeons who are increasingly ultrasound competent. In a prospective observational cohort study, Karalik et al [ 13 ] undertook BCS guided by either ultrasound (n = 84) or palpation (n = 80) amongst two groups of women matched for demographic and tumour characteristics. Use of IOUS reduced the rate of re-excision from 17% for palpation-guided lumpectomy to only 6% with IOUS.…”

Section: Intraoperative Specimen Imagingmentioning

confidence: 99%

Novel techniques for intraoperative assessment of margin involvement

Dumitru¹,

Douek²,

Benson³

2018

ecancer

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Breast conserving surgery (BCS) is now the standard of care for the majority of women with early stage breast cancer. There is a finite rate of ipsilateral breast tumour recurrence (IBTR) for breast conserving therapy (BCT) with annual rates of less than 1% for specialist breast practices.There has been recent consensus on the definition of an adequate resection margin for both invasive and noninvasive breast cancer treated with BCS, although some variation in margin policy persists with definitions of ‘no tumour at ink’, 1 and 2 mm margin mandates.Despite the development of methods for intraoperative assessment of margins, up to 20% of patients require further surgery (cavity re-excision or completion mastectomy) to achieve clear surgical margins.In the past decade, several novel technologies for intraoperative margin assessment have been explored with the aim of reducing rates of re-operation and its attendant patient anxiety, inconvenience and additional cost. Ongoing studies are addressing the safety, feasibility and cost-effectiveness of these novel technologies relative to methods in routine clinical usage.

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“…Negative surgical margins are essential to reduce the local recurrence rate after breast conserving surgery for breast cancer [1,2]. Many breast surgeons use frozen sections for intra-operative margin assessment; this helps avoid re-operation by complete re-excision during the ongoing surgery [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of intraoperative ultrasound for margin assessment in breast conserving surgery

Lee

Park

Kim

et al. 2020

Preprint

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Background: Surgical margin negativity is highly related to local recurrence of breast cancer. The authors performed this study to evaluate if specimen mammography or ultrasonography can replace the frozen section procedure for surgical margins. Methods: One-hundred fifty five patients with breast cancer were included in this study. After the surgery, the frozen biopsies were assessed in more than three different directions, and all specimens were analyzed with mammography and ultrasonography. The clinicopathologic characteristics of the patients were assessed, and closest tumor margin–resection margin distance (TM–RM distance) to the tumor was compared among specimen mammography, ultrasonography, and pathology. Results: On comparing initial cases of positive and negative margins, the mean closest TM–RM distance in specimen ultrasonography and final pathologic reports was statistically different between both groups (DCIS: p < 0.001, p = 0.006; IDC: p = 0.042, p = 0.022). Conclusion: When the closest TM–RM distance is less than 1.8 mm in specimen ultrasonography, the frozen section cannot be waived because of high risk of margin positivity. However, if the closest TM–RM distance is >4 mm in specimen ultrasonography, the frozen section can be omitted carefully because of the very low risk of margin positivity.

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Intraoperative ultrasound reduces the need for re-excision in breast-conserving surgery

Cited by 33 publications

References 35 publications

Obtaining Adequate Surgical Margin Status in Breast-Conservation Therapy: Intraoperative Ultrasound-Guided Resection Versus Specimen Mammography

Obtaining Adequate Surgical Margin Status in Breast-Conservation Therapy: Intraoperative Ultrasound-Guided Resection Versus Specimen Mammography

Novel techniques for intraoperative assessment of margin involvement

Clinical efficacy of intraoperative ultrasound for margin assessment in breast conserving surgery

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