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Ultrasound-guided breast-conserving surgery for early-stage palpable and nonpalpable invasive breast cancer: decreased excision volume at unchanged tumor-free resection margin

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Abstract

Ultrasound guidance (USG) during breast-conserving surgery improves tumor-free surgical resection margins. The objective of this study was to evaluate whether USG reduces resection volumes without compromising margin status. 134 patients with palpable or nonpalpable T1–2N0–1 invasive breast cancer were treated with USG and compared with a historical reference control group (CON) consisting of palpation-guided (PAG) or wire-guided localization (WIG) breast-conserving surgery. Primary outcomes were excess resection volume and clear margin status, and secondary outcome was re-excision rate. 66 patients underwent USG. In the CON group (n = 68), PAG was performed in 24 (35 %) and WIG in 44 (64 %) patients. Median excision volume [39 (IQR 20–66) vs 56 (38–94) cm3; p = 0.001] and median calculated resection ratio [1.7 (1.0–2.9) vs 2.8 (1.4–4.6) (p = 0.005)] were significantly smaller in the USG than in the CON group. Median minimal distance to the resection margin [4 mm (IQR 2–5 mm) vs 2 mm (1–4 mm), p = 0.004] was significantly larger. Clear resection margins were achieved in 58 of the USG patients (88 %) and in 58 of the CON patients (86 %) (p = 0.91); this was true in patients with palpable as well as nonpalpable lesions. Reexcision was needed in 6.1 and 7.2 % respectively. Relative risk for re-excision in the USG group was 0.82 (95 % CI 0.23–2.93). In patients with palpable and nonpalpable breast cancers, USG allows for lower excision volume and reduced resection of healthy breast tissue, without increased re-excision rate.

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Authors and Affiliations

  1. Department of Radiology, Gelre Hospital Apeldoorn, Oudegracht 3A, 3511 AB, Utrecht, The Netherlands

    W. A. Slijkhuis, K. E. Droogh-de Greve & J. W. C. Gratama

  2. Department of Surgery, Isala Klinieken, Zwolle, The Netherlands

    E. M. Noorda

  3. Department of Epidemiology, Gelre Hospital Apeldoorn, Utrecht, The Netherlands

    H. van der Zaag-Loonen

  4. Department of Surgery, Gelre Hospital Apeldoorn, Utrecht, The Netherlands

    M. J. Bolster-van Eenennaam & W. B. Lastdrager

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  1. W. A. Slijkhuis
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  2. E. M. Noorda
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  3. H. van der Zaag-Loonen
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  7. J. W. C. Gratama
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Correspondence to W. A. Slijkhuis.

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Slijkhuis, W.A., Noorda, E.M., van der Zaag-Loonen, H. et al. Ultrasound-guided breast-conserving surgery for early-stage palpable and nonpalpable invasive breast cancer: decreased excision volume at unchanged tumor-free resection margin. Breast Cancer Res Treat 158, 535–541 (2016). https://doi.org/10.1007/s10549-016-3914-9

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  • DOI: https://doi.org/10.1007/s10549-016-3914-9

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