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Intraoperative Ultrasound-Guided Conserving Surgery for Breast Cancer: No More Time for Blind Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Breast-conserving surgery (BCS) still remains a blind surgery despite all available tumor localization methods. Intraoperative ultrasound (IOUS) allows real-time visualization during all resection phases.

Methods

This was a prospective observational cohort study conducted at the Veneto Institute of Oncology between January 2021 and June 2022. Patients with ductal carcinoma in situ, T1-2 invasive cancer, or post-neoadjuvant tumors, suitable for BCS, were recruited. All breast cancer lesion types were included, i.e. solid palpable, solid non-palpable, non-solid non-palpable, and post-neoadjuvant treatment residual lesions. Eligible participants were randomly assigned to either IOUS or traditional surgery (TS) in a 1:1 ratio. The main outcomes were surgical margin involvement, reoperation rate, closest margin width, main specimen and cavity shaving margin volumes, excess healthy tissue removal, and calculated resection ratio (CRR).

Results

Overall, 160 patients were enrolled: 80 patients were allocated to the TS group and 80 to the IOUS group. IOUS significantly reduced specimen volumes (16.8 cm3 [10.5–28.9] vs. 24.3 cm3 [15.0–41.3]; p = 0.015), with wider closest resection margin width (2.0 mm [1.0–4.0] vs. 1.0 mm [0.5–2.0] after TS; p < 0.001). Tumor volume to specimen volume ratio was significantly higher after IOUS (4.7% [2.5–9.1] vs. 2.9% [0.8–5.2]; p < 0.001). IOUS yielded significantly better CRR (84.5% [46–120.8] vs. 114% [81.8–193.2] after TS; p < 0.001), lower involved margin rate (2.5 vs. 15%; p = 0.009) and reduced re-excision rate (2.5 vs. 12.5%; p = 0.032).

Conclusions

IOUS allows real-time resection margin visualization and continuous control during BCS. It showed clear superiority over TS in both oncological and surgical outcomes for all breast cancer lesion types. These results disfavor the paradigm of blind breast surgery.

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Authors and Affiliations

  1. Breast Surgery Unit, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy

    Massimo Ferrucci MD, PhD, Matteo Cagol MD, Tania Saibene MD, Silvia Michieletto MD, Mariacristina Toffanin MD & Alberto Marchet MD

  2. General Surgery, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy

    Francesco Milardi MD, Daniele Passeri MD & Ugo Grossi MD, PhD

  3. Breast Surgery Unit, Department of Surgery, Villa Salus Hospital, Venice, Italy

    Luaya Fabrizio Mpungu MD

  4. Unit of Biostatistics, Epidemiology and Public Health, Department of CardiacThoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy

    Andrea Francavilla MD

  5. Clinical Trials and Biostatistics, Veneto Institute of Oncology IOV, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy

    Paola Del Bianco MD, PhD

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  1. Massimo Ferrucci MD, PhD
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Correspondence to Massimo Ferrucci MD, PhD.

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Massimo Ferrucci, Francesco Milardi, Daniele Passeri, Luaya Fabrizio Mpungu, Andrea Francavilla, Matteo Cagol, Tania Saibene, Silvia Michieletto, Mariacristina Toffanin, Paola Del Bianco, Ugo Grossi, and Alberto Marchet have no conflicts of interest to disclose.

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Ferrucci, M., Milardi, F., Passeri, D. et al. Intraoperative Ultrasound-Guided Conserving Surgery for Breast Cancer: No More Time for Blind Surgery. Ann Surg Oncol 30, 6201–6214 (2023). https://doi.org/10.1245/s10434-023-13900-x

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