Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancer

Abstract

Background: Non-palpable breast lesions require some method of localization when performing breast conserving surgery (BCS). Despite the advent of newer techniques, ultrasound (US) and wire-guided localization (WGL) remain the most popular approaches.

Objective: We aim to compare the positive margin rate of US versus WGL in the excision of breast lesions.

Methods: Data were collected from the Clinical Access Portal. All patients who underwent US or WGL BCS were identified and consecutive data collected. Positive margins were evaluated using histopathology reports. Baseline demographics and specimen size data were also collected.

Results: A total of 198 patients were included in total over a three-year period. There was some evidence of an association of type of surgery with positive margin (OR=2.11, p=0.075) where a 2.11 fold increase in the odds of a positive margin was estimated for the US method relative to WGL, but this was not statistically significant at the 5% level. This effect decreased after adjusting for potential confounders (OR=1.81, p=0.34).

Conclusions: This retrospective study of US versus WGL in BCS demonstrated no significant difference in the positive margin rate, although a trend was observed in favor of the WGL group. We have provided further evidence for the debate on the accuracy of US and WGL for non-palpable breast lesions. Available data remains sparse, and our results contradict the findings of other comparative studies.

Keywords: Ultrasound; breast cancer; breast conserving surgery; margin status; radiological localization; wire localization.