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

Eggemann, Holm; Ignatov, Tanja; Beni, A.; Costa, Serban Dan; Ignatov, Atanas

doi:10.1016/j.clbc.2013.08.016

Cited by 24 publications

(9 citation statements)

References 42 publications

(80 reference statements)

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“…Because clear margins are mandatory in breast-conserving surgery [3], surgeons face the dilemma of whether to generate a minimal defect within the breast while performing a precise tumor excision, or to make a wider excision and reduce the cosmetic results [4]. However, in some types of breast cancer, intraoperative assessment of margins is difficult to perform [5, 6]. Intraoperative frozen section analysis (FSA) is the standard microscopic method for margin assessment.…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of confocal microscopy on fresh breast core needle biopsies and conventional histology

Elfgen¹,

Papassotiropoulos²,

Varga³

et al. 2019

Diagn Pathol

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Background Evaluation of core needle biopsies (CNB) is a standard procedure for the diagnosis of breast cancer. However, tissue processing and image preparation is a time- consuming procedure and instant on-site availability of high-quality images could substantially improve the efficacy of the diagnostic procedure. Conventional microscopic methods, such as frozen section analysis (FSA) for detection of malignant cells still have clear disadvantages. In the present study, we tested a confocal microscopy scanner on fresh tissue from CNB with intention to develop an alternative device to FSA in clinical practice. Patients and methods In 24 patients with suspicious breast lesions standard of care image-guided biopsies were performed. Confocal images have been obtained using the Histolog™ Scanner and evaluated by two independent pathologists. Hematoxylin-Eosin (H&E) histological sections of the biopsies were routinely processed in a blinded fashion with respect to the confocal images. Results In total 42 confocal images were generated from 24 biopsy specimens, and available for analysis within a few minutes of taking the biopsy. This resulted in 2 × 42 = 84 pathologic evaluations. In four cases, a pathologic diagnosis was not possible with confocal microscopy. An exact correlation based on the B-classification was reached in 41 out of 80 examinations and in another 35 cases in a broader sense of correspondence definition (i.e. malignant vs. benign). Conclusions As a reliable on-site method, the Histolog™ Scanner provides a visualization of cellular details equivalent to the H&E standards, permitting rapid and accurate diagnosis of malignant and benign breast lesions. Furthermore, this device offers great potential for immediate margin analysis of specimen in breast conserving therapy.

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Section: Introductionmentioning

confidence: 99%

Comparative analysis of confocal microscopy on fresh breast core needle biopsies and conventional histology

Elfgen¹,

Papassotiropoulos²,

Varga³

et al. 2019

Diagn Pathol

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“…Removed tissue volumes were higher in the palpation-guided cohort in most studies. In contrast, Eggemann et al reported higher specimen volumes in the IOUS group, but the difference was not statistically significant [26].…”

Section: Meta-analysis Of Rcts In Palpable Breast Cancermentioning

confidence: 85%

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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“…This study also evaluated the cosmetic outcome after ultrasoundguided lumpectomy, IOUS enabled the achievement of optimal resection volumes thanks to the less removal of healthy breast tissue, resulting in better aesthetic results and in greater patient satisfaction. Finally, Eggemann et al 23 obtained a 27.7 per cent rate of positive margins in the palpation-guided lumpectomy group compared with the 12.1 per cent one of the ultrasoundguided lumpectomy group.…”

Section: Discussionmentioning

confidence: 96%

Ultrasound-Guided Breast-Conservative Surgery Decreases the Rate of Reoperations for Palpable Breast Cancer

Vieni

Graceffa

Priola

et al. 2018

The American Surgeon

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The purpose of this study is to verify whether the performance of ultrasound-guided quadrantectomy (USGQ) versus palpation-guided quadrantectomy (PGQ) can reduce the incidence of positive margins and if it can change the attitude of the surgeon. A retrospective study was conducted on 842 patients underwent quadrantectomy for breast cancer, 332 of them underwent USGQ, whereas 550 underwent PGQ. The histological type of the tumors and the margin status obtained with the histological examination were compared. The histological examination of the surgical specimen showed involvement of the margins in 24/842 patients (2.85%), 22 (2.61%) of them belonged to the PGQ group, and two to the USGQ group (P = 0.0011). The highest rate of microscopically positive margins was, statistically significant, for carcinoma in situ, when compared with patients with invasive carcinoma (0.0001). USGQ technique showed several advantages compared with PGQ. In fact, the former notes a lower positive margin rate and, consequently, a lower rate of reintervention. In addition, it may change the surgeon's attitude by causing him to remove another slice of margin to ensure more histological negativity. It should be the gold standard technique for breast-conservative surgery of palpable tumors.

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

Abstract: US-guided BCS is superior to palpation-guided excision in predicting the closest margins, obtaining clear surgical margins, and reducing re-operations.

Cited by 24 publications

References 42 publications

Comparative analysis of confocal microscopy on fresh breast core needle biopsies and conventional histology

Comparative analysis of confocal microscopy on fresh breast core needle biopsies and conventional histology

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

Ultrasound-Guided Breast-Conservative Surgery Decreases the Rate of Reoperations for Palpable Breast Cancer

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