Geburtshilfe Frauenheilkd 2014; 74 - PO_Onko04_03
DOI: 10.1055/s-0034-1388386

Ultrasound-guided breast-conserving surgery is superior to the palpation-guided surgery for palpable breast cancer

A Ignatov 1, T Ignatov 1, SD Costa 1, H Eggemann 1
  • 1Universitätsfrauenklinik, Magdeburg, Germany

Purpose: The aim of this study was to determine the efficacy of ultrasound (US)-guided excision of palpable breast cancer and to compare it with the standard palpation-guided breast conserving surgery (BCS).

Methods: For this purpose 335 women with palpable breast cancer who underwent BCS were retrospectively studied. The positive surgical margins and re-excision rates were investigated.

Results: Of the total cohort, 137 patients were treated with palpation-guided BCS and 198 underwent US-guided tumor excision. The tumor and patient characteristics were similar in both groups. Patient age, postmenopausal status, tumor size, histological grade, intraductal tumor component, lobular histology and palpation-guided tumor excision were associated with increased risk of positive margins. The shave margins were re-excised at the time of original operation more often by palpation-guided localization (28.5%) than in the US-guided group (11.1%) (p < 0.0001). The surgeon was able to correctly identify the “problematic” margin in 81.1% of cases via intraoperative US and in only 17.9% via palpation (p < 0.0001). The re-excision rate during a second operation was significantly reduced by US-guided tumorectomy (p = 0.004). Twenty-three of 198 (11.6%) patients in the US-guided group and 33 of 137 (24.1) patients in the palpation group underwent a second operation. The sensitivity and specificity of US-guided excision were 52.7% and 97.5%, whereas the sensitivity and the specificity of palpation-guided tumor excision were 15.5% and 65.9%, respectively.

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