A comparative study of perioperative techniques to attain negative margins and spare healthy breast tissue in breast conserving surgery

2021 ◽  
Vol 39 (3-4) ◽  
pp. 127-135
Author(s):  
Kanyadhara Lohita Krishna ◽  
B.S. Srinath ◽  
Divya Santosh ◽  
Shanthi Velusamy ◽  
K.P. Divyamala ◽  
...  
Keyword(s):  
Comparative Study ◽  
Breast Tissue ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Ultrasound Guided ◽  
Positive Margins ◽  
Guided Surgery ◽  
Surgery Group ◽  
Excess Amount ◽  
Resection Volume

BACKGROUND AND AIM: Traditionally lumpectomy as a part of breast-conserving surgery (BCS) is performed by palpation-guided method leading to positive margins and large excision volumes. There is no evidence suggesting that wide margin excisions decrease intra-breast tumour recurrence. Various perioperative techniques are used for margin assessment. We aimed to compare three commonly used techniques, i.e., ultrasound-guided surgery, palpation-guided surgery and cavity shaving for attaining negative margins and estimating the extent of healthy breast tissue resection. METHOD: A prospective comparative study was performed on 90 patients who underwent breast conservation surgery for early breast cancer between August 2018 and June 2019. Tumour excision with a minimum of 1 cm margin was done either using ultrasound, palpation or cavity shaving. Histopathological evaluation was done to assess the margin status and excess amount of resected normal breast tissue. Calculated resection ratio (CRR) defining the excess amount of the resected breast tissue was achieved by dividing the total resection volume (TRV) by optimal resection volume (ORV). The time taken for excision was also recorded. RESULTS: Histopathology of all 90 patients (30 in each group) revealed a negative resection margin in 93.3% of 30 patients in palpation-guided surgery group and 100% in both ultrasound-guided surgery and cavity shaving groups. Two patients (6.7%) from the cavity shaving group had positive margins on initial lumpectomy but shave margins were negative. TRV was significantly less in the ultrasound-guided surgery group compared to the palpation-guided surgery group and cavity shaving group (76.9 cm3, 94.7 cm3 and 126.3 cm3 respectively; p < 0.0051). CRR was 1.2 in ultrasound group compared to 1.9 in palpation group and 2.1 in cavity shave group which was also statistically significant (p < 0.0001). Excision time was significantly less (p < 0.001) in palpation-guided surgery group (13.8 min) compared to cavity shaving group (15.1 min) and ultrasound-guided group (19.4 min). CONCLUSION: Ultrasound-guided surgery is more accurate in attaining negative margins with the removal of least amount of healthy breast tissue compared to palpation-guided surgery and cavity shaving.

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

2018 ◽  
Vol 40 (03) ◽  
pp. 326-332 ◽  
Author(s):  
Jürgen Hoffmann ◽  
Mario Marx ◽  
Andreas Hengstmann ◽  
Harald Seeger ◽  
Ernst Oberlechner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Surgery ◽  
Resection Margins ◽  
Wire Localization ◽  
Single Center ◽  
Ultrasound Guided ◽  
Guided Surgery ◽  
Duration Of Surgery ◽  
Ultrasound Assisted ◽  
Resection Volume

Abstract Purpose Breast-conserving therapy is associated with a risk of tumor-involved margins. For intraoperative orientation, non- palpable or indistinctly palpable lesions are wire-marked prior to surgery. Ultrasound-guided surgery has the potential to reduce the number of tumor-involved margins. In the MAC 001 trial we evaluated ultrasound-guided breast-conserving surgery compared to wire-guided surgery with regard to free tumor margins, duration of surgery and resection volume. Materials and Methods In this randomized, prospective, single-center controlled trial, patients with ductal invasive breast cancer were recruited for either ultrasound-guided or wire localization surgery. Primary outcomes were tumor-free resection margins, the reoperation rate and the resection volume in each group. The results were analyzed by intention to treat. The trial was registered under ClinicalTrials.gov NCT02222675. Results 56 patients were assessed, and 47 patients were evaluated in the trial. 93 % (25/27) of the patients in the ultrasound arm had an R0 reoperation compared to 65 % (13/20) in the wire localization control arm. This result was statistically significant (p = 0.026). No statistical difference was found for the resection volume or the duration of surgery between the two arms. No major complication was seen in either arm. Conclusion Ultrasound-assisted breast surgery significantly increases the possibility of tumor-free margins and therefore reduces the risk of reoperations. Breast surgeons should be trained in ultrasound and ultrasound should be available in every breast surgery operating room.

scholarly journals Oncoplastic Breast-Conserving Surgery in Iceland: A Population-Based Study

2018 ◽  
Vol 107 (3) ◽  
pp. 224-229 ◽  
Author(s):  
E. P. Palsdottir ◽  
S. H. L. Lund ◽  
K. S. A. Asgeirsson
Keyword(s):  
Patient Satisfaction ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Breast Conservation ◽  
Breast Conserving Surgery ◽  
Population Based ◽  
Breast Conservation Surgery ◽  
Population Based Study ◽  
Surgery Group ◽  
Conservation Surgery

Background and Aims: In Iceland, oncoplastic breast-conservation surgery has been performed since 2008. The aim of this population-based study was to assess and compare the efficacy and patient satisfaction of standard breast-conservation surgery with oncoplastic breast-conservation surgery. Materials and methods: This is a population-based, retrospective, observational cohort study on all women undergoing breast-conservation surgery in Iceland from the 1 January 2008 to 31 December 2014. A multivariate logistic regression and linear regression were performed to assess differences in outcomes and a patient satisfaction questionnaire was used to assess certain patient-related outcome measures. Results and conclusion: A total of 750 women underwent breast-conserving surgery, 665 had standard breast-conservation surgery and 85 oncoplastic breast-conservation surgery. Oncoplastic breast-conservation surgery was associated with a significantly larger mean size (2.4 cm vs 1.7 cm, p < 0.001) and weight (181.8 g vs 63.4 g, p < 0.001) of breast specimen excised when compared to standard breast-conservation surgery. After correcting for confounding factors, there was no significant difference in surgical margin involvement (odds ratio = 0.97, confidence interval = 0.44–1.97), frequency of complications (odds ratio = 1.06, confidence interval = 0.46–2.18), frequency of reoperations (odds ratio = 0.98; confidence interval = 0.50–1.81), or time to first adjuvant therapy (–0.23 days for oncoplastic breast-conservation surgery, p = 0.95). Patient satisfaction was high in both groups, although not statistically different (96% in oncoplastic breast-conservation surgery group vs 89% in the standard breast-conservation surgery group, p = 0.84). Our results show that oncoplastic breast-conservation surgery is at least as safe as standard breast-conservation surgery in selected cases and may be preferable in ductal carcinoma in situ.

scholarly journals Intraoperative B-Mode Ultrasound Guided Surgery and the Extent of Glioblastoma Resection: A Randomized Controlled Trial

2021 ◽  
Vol 11 ◽  
Author(s):  
Fatih Incekara ◽  
Marion Smits ◽  
Linda Dirven ◽  
Eelke M. Bos ◽  
Rutger K. Balvers ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Intraoperative Ultrasound ◽  
Complete Resection ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Guided Surgery ◽  
Randomized Controlled ◽  
Surgery Group ◽  
Ultrasound Group

BackgroundIntraoperative MRI and 5-aminolaevulinic acid guided surgery are useful to maximize the extent of glioblastoma resection. Intraoperative ultrasound is used as a time-and cost-effective alternative, but its value has never been assessed in a trial. The goal of this randomized controlled trial was to assess the value of intraoperative B-mode ultrasound guided surgery on the extent of glioblastoma resection.Materials and MethodsIn this randomized controlled trial, patients of 18 years or older with a newly diagnosed presumed glioblastoma, deemed totally resectable, presenting at the Erasmus MC (Rotterdam, The Netherlands) were enrolled and randomized (1:1) into intraoperative B-mode ultrasound guided surgery or resection under standard neuronavigation. The primary outcome of this study was complete contrast-enhancing tumor resection, assessed quantitatively by a blinded neuroradiologist on pre- and post-operative MRI scans. This trial was registered with ClinicalTrials.gov (NCT03531333).ResultsWe enrolled 50 patients between November 1, 2016 and October 30, 2019. Analysis was done in 23 of 25 (92%) patients in the intraoperative B-mode ultrasound group and 24 of 25 (96%) patients in the standard surgery group. Eight (35%) of 23 patients in the intraoperative B-mode ultrasound group and two (8%) of 24 patients in the standard surgery group underwent complete resection (p=0.036). Baseline characteristics, neurological outcome, functional performance, quality of life, complication rates, overall survival and progression-free survival did not differ between treatment groups (p&gt;0.05).ConclusionsIntraoperative B-mode ultrasound enables complete resection more often than standard surgery without harming patients and can be considered to maximize the extent of glioblastoma resection during surgery.

scholarly journals Ultrasound Image Features under Deep Learning in Breast Conservation Surgery for Breast Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Hongxu Zhang ◽  
Haiwang Liu ◽  
Lihui Ma ◽  
Jianping Liu ◽  
Dawei Hu
Keyword(s):  
Breast Cancer ◽  
Deep Learning ◽  
Ultrasound Guidance ◽  
Tumor Resection ◽  
Breast Conservation ◽  
Ultrasound Image ◽  
Breast Conserving Surgery ◽  
Cosmetic Effect ◽  
Resection Volume ◽  
Tumor Area

This study was to analyze the effect of the combined application of deep learning technology and ultrasound imaging on the effect of breast-conserving surgery for breast cancer. A deep label distribution learning (LDL) model was designed, and the semiautomatic segmentation algorithm based on the region growing and active contour technology (RA) and the segmentation model based on optimized nearest neighbors (ON) were introduced for comparison. The designed algorithm was applied to the breast-conserving surgery of breast cancer patients. According to the difference in intraoperative guidance methods, 102 female patients with early breast cancer were divided into three groups: 34 cases in W1 group (ultrasound guidance based on deep learning segmentation model), 34 cases in W2 group (ultrasound guidance), and 34 cases in W3 group (palpation guidance). The results revealed that the tumor area segmented by the LDL algorithm constructed in this study was closer to the real tumor area; the segmentation accuracy (AC), Jaccard, and true-positive (TP) values of the LDL algorithm were obviously greater than those of the RA and ON algorithms, while the false-positive (FP) value was significantly lower in contrast to the RA and ON algorithms, showing statistically observable differences ( P  < 0.05); the actual resection volume of the patients in the W1 group was the closest to the ideal resection volume, which was much smaller in contrast to that of the patients in the W2 and W3 groups, showing statistical differences ( P  < 0.05); the positive margins of the patients in the W1 group were statistically lower than those in the W2 and W3 groups ( P  < 0.05). In addition, 1 patient in the W1 group was not satisfied with the cosmetic effect, 3 patients in the W2 group were not satisfied with the cosmetic effect, and 9 patients in the W3 group were not satisfied with the cosmetic effect. Finally, it was found that the ultrasound image based on the deep LDL model effectively improved the AC of tumor resection and negative margins, reduced the probability of normal tissue being removed, and improved the postoperative cosmetic effect of breast.

Low re-excision rate for positive margins in patients treated with ultrasound-guided breast-conserving surgery

The Breast ◽  
2013 ◽  
Vol 22 (5) ◽  
pp. 698-702 ◽  
Author(s):  
Chi-Chang Yu ◽  
Kun-Chun Chiang ◽  
Wen-Lin Kuo ◽  
Shih-Che Shen ◽  
Yung-Feng Lo ◽  
...  
Keyword(s):  
Breast Conserving Surgery ◽  
Ultrasound Guided ◽  
Positive Margins ◽  
Excision Rate
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