AGO Recommendations for the Surgical Therapy of Breast Cancer: Update 2022 (original) (raw)
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Ultrasound-guided preoperative localization of breast lesions: a good choice
Journal of Ultrasound, 2018
The aim of the study was to verify whether ultrasound (US)-guided preoperative localization of breast lesions is an adequate technique for correct and safe surgical resection and to contribute positively and effectively to this topic in the literature with our results. Methods From June 2016 to November 2016, 155 patients with both benign and malignant breast lesions were selected from our institute to undergo US localization before surgery. The lesions included were: • sonographically visible and nonpalpable lesions; • palpable lesions for which a surgeon had requested US localization to better evaluate the site and extension; • sonographically visible, multifocal breast lesions, both palpable and nonpalpable. US localization was performed using standard linear transducers (Siemens 18 L6, 5.5-8 MHz, 5.6 cm, ACUSON S2000 System, Siemens Medical Solutions). The radiologist used a skin pen to mark the site of the lesion, and the reported lesion's depth and distance from the nipple and pectoral muscle were recorded. The lesions were completely excised by a team of breast surgeons, and the surgical specimens were sent to the Radiology Department for radiological evaluation and to the Pathology Department for histological assessment. Results In 155 patients who underwent to preoperative US localization, 188 lesions were found, and the location of each lesion was marked with a skin pen. A total of 181 lesions were confirmed by the final histopathologic exam (96.28%); 132 of them (72.92%) were malignant, and 124 of these (93.93%) showed free margins. Conclusions US-guided preoperative localization of sonographically visible breast lesions is a simple and nontraumatic procedure with high specificity and is a useful tool for obtaining accurate surgical margins. Keywords Breast • Ultrasound • Localization • Skin tattoo • Histopathologic exam • Breast cancer Sommario Obiettivo Lo scopo dello studio è di verificare se la localizzazione preoperatoria eco-guidata delle lesioni mammarie sia una tecnica adeguata per una corretta e sicura resezione chirurgica ed è altresì quello di contribuire positivamente ed efficacemente, con i risultati ottenuti dal nostro istituto, all'approfondimento di questo argomento nella letteratura scientifica. Metodi Dal giugno 2016 al novembre 2016, 155 pazienti con lesioni mammarie benigne e maligne sono state selezionate dal nostro istituto per sostenere una localizzazione ecografica prima della seduta chirurgica. Le lesioni considerate sono state: • lesioni ecograficamente visibili e non palpabili; • lesioni palpabili per le quali il chirurgo avesse richiesto una localizzazione ecografica per meglio valutarne sito ed estensione; • lesioni mammarie multifocali, ecograficamente visibili, sia palpabili che non palpabili.
Breast Cancer Research and Treatment, 2013
Introduction The current standard of treatment for non-palpable breast cancers is wire-guided localization (WGL). WGL has its drawbacks and alternatives such as radio-guided surgery (RGL) and intra-operative ultrasound (IOUS) have been developed. The clinical effectiveness of all forms of RGL has been assessed against WGL in previous systematic reviews and meta-analyses. We performed the first systematic review and meta-analysis of IOUS in the management of non-palpable breast cancers. Methods Studies were considered eligible for inclusion in this systematic review if they (1) assessed the role of surgeon-performed IOUS for the treatment of non-palpable breast cancers and ductal carcinoma in situ (DCIS) and (2) specified surgical margin excision status. Those studies, which were randomized controlled trials (RCTs) or cohort studies with comparison WGL groups were included in the meta-analysis. For those studies included in the meta-analysis, pooled odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated using fixed-effects analyses and random-effects analyses in case of statistically significant heterogeneity (p \ 0.05). Results Eighteen studies reported data on IOUS in 1,328 patients with non-palpable breast cancer and DCIS. Nine cohort studies with control WGL groups and one RCT were included in the meta-analysis. Successful localization rates varied between 95 and 100 % in all studies and there was a statistically significant difference in the rates of involved surgical margins in favour of IOUS with pooled OR 0.52 (95 % CI 0.38-0.71). Conclusion Compared with WGL, IOUS reduces involved surgical margin rates. Adequately powered RCTs are required to validate these findings.
Breast Cancer Research and Treatment, 2012
Intraoperative ultrasound (IOUS) can be used in the operation theatre for localization of non-palpable breast cancers. In this prospective cohort study, we compared the yield of IOUS to guidewire localization (GWL). A total of 258 consecutive patients with non-palpable invasive breast cancer underwent breast conserving surgery between 1999 and 2010. GWL was performed in 138 (54 %) and IOUS in 120 (46 %) patients. Tumor dimensions, resection volume, margin status and re-excision rates were compared by means of multivariate regression analysis. The groups were similar in terms of age, histological subtype and presence of DCIS. Lesions in the IOUS group were larger (1.24 vs. 0.98 cm, P \ 0.001), while microcalcifications were more common in the GWL group (19 vs. 3 %, P \ 0.001). Even after stratification for tumor diameter, presence of DCIS and findings on mammography, resection volumes were similar in both groups. Tumor-free resection margins were obtained in [93 % of patients (93.5 % with GWL vs. 93.3 % with IOUS, P = 0.958) and re-excision was performed in 11 % of patients undergoing GWL and 12.5 % of patients undergoing IOUS (P = 0.684). For localization of nonpalpable breast cancer, IOUS is a reliable alternative to GWL, as it achieves similar results in terms of complete tumor removal, re-excision rate and excised volume.
Current status of ultrasound-guided surgery in the treatment of breast cancer
World Journal of Clinical Oncology, 2016
Author contributions: Volders JH and van den Tol MP con ceived and coordinated the study and wrote the paper, they performed the majority of literature research and analyzed current articles; Haloua MH, krekel NMA and Meijer S have been involved in drafting the manuscript and revising it critically for important intellectual content, they performed additional literature research with analysis and interpretation of data; all authors reviewed the results and approved the final version of the manuscript. Conflict-of-interest statement: The authors whose names are listed above certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus, membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements). The authors declare no conflicts of interest regarding this manuscript.
The Breast, 2017
Background: Intraoperative ultrasound guided (IUG) breast conserving surgery (BCS) is being increasingly embraced by breast surgeons worldwide. We aimed to compare the efficacy of IUG-BCS for palpable and nonpalpable breast cancer with respect to margin status, re-excision rate, tissue sacrifice and costtime analysis. Methods: Intraoperative localization protocol includes intraoperative ultrasound prior to excision to localize the lesion and guide the initial resection. The excised specimen was then examined visually and by palpation and the specimen and cavity was examined with ultrasound. Frozen sections were obtained routinely from a portion of all six faces of the resected specimen, and shaved cavity margins were sent for permanent histology. Results: Of the 208 patients, 57.2% had nonpalpable tumors. The sensitivity of ultrasound localization was 100%. Negative margins were achieved in 92.43% of nonpalpable and 91.01% of palpable lesions at initial procedure. The involved margins were correctly identified by the surgeon via specimen sonography in 95.4% of cases. Final positive margin rate was 2.4%. Calculated resection ratio and time analysis revealed nothing significant. Conclusion: IUG-BCS is an invaluable and effective modality for obtaining clear surgical margins with optimum resection volumes and reducing re-operations. Furthermore, by means of this algorithm, in case of shaving cavity margins of the tumor bed for permanent analysis, frozen section evaluation might be omitted.
The Lancet Oncology, 2013
Background Breast-conserving surgery for palpable breast cancer is associated with tumour-involved margins in up to 41% of cases and excessively large excision volumes. Ultrasound-guided surgery has the potential to resolve both of these problems, thereby improving surgical accuracy for palpable breast cancer. We aimed to compare ultrasoundguided surgery with the standard for palpable breast cancer-palpation-guided surgery-with respect to margin status and extent of healthy breast tissue resection.
Intraoperative ultrasound reduces the need for re-excision in breast-conserving surgery
World Journal of Surgical Oncology, 2015
Background: The purpose of this study was to evaluate ultrasound-guided surgery for palpable breast cancer by comparing the standard palpation-guided surgery in terms of the extent of healthy breast tissue resection, the percentage of tumor-free margins, and cosmetic outcomes. Methods: This was a prospective, observational cohort study conducted from January 2009 to July 2011. Breast cancer patients, diagnosed via biopsy, were operated in guidance with either ultrasound or palpation. Patient demographics, tumor features, intraoperative findings, pathologic and cosmetic results, intraoperative-measured ultrasound margins, and pathology margins were compared. Results: Ultrasound (US)-guided lumpectomy was performed on 84 women and palpation-guided lumpectomy on 80 women. Patient demographics and tumor characteristics showed no differences. The rate of re-excision was 17 % for the palpation-guided surgery group, and 6 % for the US-guided group (p = 0.03). There was good correlation between the closest margins recorded by US and pathology margins (r = 0.76, p = 0.01). Volume of resection was significantly larger in the palpation-guided group despite the similar size of tumors (p = 0.048). Cosmetic outcome of surgery was equivalent between groups. Conclusions: Intraoperative ultrasound guidance for excision of palpable breast cancers is feasible and gives results in terms of pathologic margins that are comparable with those achieved by standard palpation-guided excisions.
Indian Journal of Surgical Oncology, 2019
For clinically low-volume breast cancer patients subjected to BCS, there is a concern regarding achieving microscopically negative margins and avoiding inadvertent resection of excessive volume of breast tissue. In this study, we utilized intraoperative ultrasound to guide resection in patients subjected to BCS. This was compared with palpation-guided resection. A total of 80 patients of invasive breast carcinoma (T1-2, N0-1, M0) (39 patients in USG-guided BCS (group A) and 41 patients in palpationguided BCS (group B)) were enrolled. In group A, intraoperative localization was performed using a multifrequency 10-MHz linear array ultrasound probe and tumors were excised under USG guidance. In group B, tumor excision was guided by the palpation skills of the surgeon with the aim of achieving grossly negative margin circumferentially. Specimen volume was measured using water displacement technique. One out of 39 patients (2.56%) in group A and 5 out of 41(12.19%) in group B had positive margin in histopathology report. Mean of specimen volume in groups A and B was 42.67 and 57.97 ml respectively (P = 0.011). Mean of excess volume removed in study group was 4.19 ml and in control group, it was 24.11 ml (P = < 0.01). Mean of calculated resection ratio in study group was 1.1 and in control group was 1.73 (P = 0.01). Use of intraoperative ultrasound during BCS may help in improving margin clearance, reducing additional procedures, and preserving the normal breast parenchyma. The safety, ease, and effectivity of this technique may result in its wider application in future.