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Comparative Study
. 2012 Aug;215(2):237-43.
doi: 10.1016/j.jamcollsurg.2012.04.018. Epub 2012 May 24.

Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice

Gregory Larrieux  1 , Julie A Cupp, Junlin Liao, Carol E H Scott-Conner, Ronald J Weigel
Affiliations
Comparative Study

Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice

Gregory Larrieux et al. J Am Coll Surg. 2012 Aug.

Abstract

Background: Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice.

Study design: Patients with nonpalpable lesions who underwent NL or HUG lumpectomy from January 2007 to December 2009 by a single surgeon were identified from a breast surgery database. Ease of scheduling, volume excised, re-excision rates, operating room time, and health care charges were the main outcomes variables. Univariate and multivariate analyses were performed to compare the 2 groups.

Results: Lumpectomy was performed in 110 patients, 55 underwent HUG and 55 underwent NL. Hematoma ultrasound-guided lumpectomy was associated with a nearly 3-fold increase in the odds ratio of additional tissue being submitted to pathology (p = 0.039), but neither the total amount of breast tissue removed, nor the need for second procedure were statistically different between the 2 groups. Duration of the surgical procedure did not vary between the 2 groups; however, the time from biopsy to surgery was shorter for HUG by an expected 9.7 days (p = 0.019), implying greater ease of scheduling. Mean charges averaged $250 less for HUG than for NL, but this difference was not statistically significant.

Conclusions: Hematoma ultrasound-guided is equivalent to NL with regard to volume of tissue excised, need for operative re-excision, and operating room time. Adoption of HUG in our practice allowed for more timely surgical care.

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Figures

Figure 1
Figure 1
(A) Preoperative breast ultrasound showing hematoma and biopsy clip. (B) X-ray of lumpectomy specimen showing biopsy clip and margin markers.
Figure 2
Figure 2
Comparison of the volume of total tissue removed.
Figure 3
Figure 3
Re-excision rates between hematoma ultrasound-guided and needle localization.
See this image and copyright information in PMC

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