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

2020 ◽  
Vol 26 (11) ◽  
pp. 2308-2311
Author(s):  
Jeeyeon Lee ◽  
Ho Yong Park ◽  
Wan Wook Kim ◽  
Chan Sub Park ◽  
Yungeun Ji ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Intraoperative Ultrasound ◽  
Breast Conserving Surgery ◽  
Margin Assessment

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

2020 ◽  
Author(s):  
Jeeyeon Lee ◽  
Ho Yong Park ◽  
Wan Wook Kim ◽  
Chan Sub Park ◽  
Yungeun Ji ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Resection Margin ◽  
Frozen Section ◽  
Intraoperative Ultrasound ◽  
Surgical Margin ◽  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Clinicopathologic Characteristics ◽  
Tumor Margin ◽  
The Mean

Abstract 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.

Intraoperative ultrasound for improvement of re-excision rates in breast-conserving surgery.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 91-91
Author(s):  
M. Knauer ◽  
P. Tschann ◽  
R. Koeberle-Wuehrer ◽  
U. Obwegeser ◽  
Z. Jasarevic ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Resection Margin ◽  
Intraoperative Ultrasound ◽  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Primary Tumors ◽  
Breast Surgeon ◽  
Cheap Method ◽  
Excision Rate

91 Background: Due to improved screening for early breast cancer, the percentages of small and nonpalpable breast tumors have significantly increased during the last decades. After lumpectomy, re-excision rates of 32%-63% have been reported and the routine placement of localization needles is painful, time-consuming, and costly. In this study we investigated the value of intraoperative ultrasound (IOUS) in the hand of the breast surgeon as a fast and cheap method for potentially improving unacceptable re-excision rates. Methods: Between July 2001 and December 2010, in 773 of 1,195 breast cancer patients a breast-conserving treatment has been performed at the certified breast care center Vorarlberg (breast-conservation rate 64.7%). In 74.9% (579/773) of the tumors IOUS was performed, of which 44% were nonpalpable and 56% were insufficiently palpable, respectively. 7.5-10 MHz linear ultrasound probes were used by four breast surgeons in combination with intraoperative macroscopic resection margin assessment by the pathologist for prospective evaluation of definitive resection margin status over time. Furthermore, local recurrence rates were assessed. Results: During the study period, 579 of the included primary tumors were detected by IOUS. The metachronous re-excision rate was halved from 22% (30/135) in the period 2001-2003 to 11% (13/121) between 2008 and 2010. Between 2001 and 2010 we achieved a total re-excision rate of 13% (74/579). In 53% of re-excision specimens, no residual tumor was present, in 23% DCIS and in 24% invasive tumor was found, respectively. At a median follow-up of 56.4 months, a local recurrence rate of 1.7% was observed using our approach of IOUS combined with intraoperative margin assessment. Conclusions: IOUS in the hand of the breast surgeon proved to be a valuable, fast, and cheap method to improve metachronous re-excision rates in breast-conserving surgery. Patients can be spared the painful, costly, and time-consuming placement of a localization needle. Furthermore, tissue-sparing operations can be performed more easily and intraoperative specimen radiography can be avoided. The actual pathologic tumor size, however, is often being underestimated, especially regarding in situ cancers.

scholarly journals OBTAINING ADEQUATE SURGICAL MARGIN STATUS IN BREAST-CONSERVATION THERAPY: INTRAOPERATIVE ULTRASOUND-GUIDED RESECTION VERSUS SPECIMEN MAMMOGRAPHY

2018 ◽  
Vol 91 (2) ◽  
pp. 197-202
Author(s):  
Maria Mihaela Pop ◽  
Silviu Cristian ◽  
Orsolya Hanko-Bauer ◽  
Dana Valentina Ghiga ◽  
Rares Georgescu
Keyword(s):  
Sensitivity And Specificity ◽  
Breast Conservation ◽  
Intraoperative Ultrasound ◽  
Positive Margin ◽  
Margin Status ◽  
Resected Specimen ◽  
Margin Assessment ◽  
Positive Margins ◽  
Positive Correlation ◽  
Intraoperative Margin Assessment

Background and aim. The 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.Method. A 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.Results. We 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.Conclusions. According 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.

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

2015 ◽  
Vol 13 (1) ◽  
Author(s):  
Hasan Karanlik ◽  
Ilker Ozgur ◽  
Dilek Sahin ◽  
Merdan Fayda ◽  
Semen Onder ◽  
...  
Keyword(s):  
Intraoperative Ultrasound ◽  
Breast Conserving Surgery

Intraoperative margin assessment and re-excision rate in breast conserving surgery

2004 ◽  
Vol 30 (3) ◽  
pp. 233-237 ◽  
Author(s):  
F.J Fleming ◽  
A.D.K Hill ◽  
E.W Mc Dermott ◽  
A O'Doherty ◽  
N.J O'Higgins ◽  
...  
Keyword(s):  
Breast Conserving Surgery ◽  
Margin Assessment ◽  
Intraoperative Margin Assessment ◽  
Excision Rate
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