Localization of nonpalpable breast lesions with sonographically visible clip: optimizing tailored resection and clear margins

Abstract

Background: Achieving clear margins with adequate resection volumes is one of the principal goals of breast-conserving surgery. The aim of our study was to compare preoperative localization using 2 different clips, radiopaque or sonographically visible, to reach this goal.

Methods: We reviewed 209 consecutive nonpalpable breast cancers that were treated with lumpectomy: 59 with radiopaque and 150 with sonographically visible clip positioned during biopsy procedure. In the former case, preoperative localization was performed with mammography and in the latter by ultrasonography.

Results: Clear margins were achieved in 80.4% of patients: 57.6% in the first and 89.3% in the second group (P < .0001; odds ratio, 7.6; 95% confidence interval, 3.4 to 17.2). By using sonographically visible clips, the re-excision rate has decreased from 42.4% to 10.7%, (P < .0001), and resections resulted smaller with average calculated resection ratio of 3.54 vs. 5.08 (P = .03).

Conclusions: Preoperative localization using a sonographically visible clip allows a more tailored breast-conserving surgery and reduces the re-excision rate.

Keywords: Breast-conserving surgery; Clip; Margin status; Nonpalpable breast cancer; Resection volume; Ultrasonography.