Intraoperative Ultrasound 'Imperative' in Breast Conserving Surgery

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(ChemotherapyAdvisor) – Ultrasound-guided surgery should become the new standard of care for excising palpable breast cancer tumors, investigators concluded during the 8th European Breast Cancer Conference in Vienna, Austria, March 23.

Not only does ultrasound-guided surgery “prevent the unacceptably high rate of tumor-involved resection margins in palpable breast cancer excision,” thus avoiding subsequent surgery or radiotherapy, the procedure contributes to improved cosmetic results largely by reducing the amount of unnecessary healthy breast tissue resection to optimal volume resection, Nicole Krekel, MD, from VU University Medical Center, Amsterdam, The Netherlands, and colleagues concluded.

They randomized 124 patients with palpable T1-T2 invasive breast cancer to ultrasound-guided surgery (n=61) or standard palpation-guided surgery (n=63) and analyzed specimen margins for tumor invasion. In the group that received ultrasound-guided surgery, 3.3% of margins had invasive carcinoma vs. 16.4% in the control group (P<0.05). “The use of intraoperative ultrasound resulted in a significant reduction of re-excisions, mastectomies, and irradiation boosts,” they found.

In the ultrasound-guided surgery group, the excision volume was 40cc vs. 58cc in the palpation-guided surgery arm (P<0.05); the calculated resection ratio (CRR) was also smaller: 1.0 (e.g., the ideal) vs. 1.9 (P<0.05). Tumors larger than 2.0cm were associated with lower CRR (P<0.0001), but a higher positive margin rate (P=0.064).

“The clinical implications of our study are tremendous and we believe they should be included in international guidelines,” Dr. Krekel said. “Given the overwhelming advantages of ultrasound-guided surgery, ‘blind,' palpation-guided excisions should be completely replaced, with ultrasound-guided surgery becoming the standard of care for both palpable and non-palpable breast cancer surgery.”

Abstract (Enter "Krekel” in the author box to search for Abstract No. 1)

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