Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;26(9):1680-1687.
doi: 10.1111/tbj.13992. Epub 2020 Jul 30.

Intraoperative ultrasonography-guided surgery: An effective modality for breast conservation after neo-adjuvant chemotherapy

Ilhan Tasdöven  1 , Güldeniz Karadeniz Çakmak  1 , Ali Ugur Emre  1 , Hüseyin Engin  2 , Burak Bahadır  3 , Hakan Bekir Bakkal  4 , Mahmut Bahadır Güllüoğlu  5
Affiliations

Intraoperative ultrasonography-guided surgery: An effective modality for breast conservation after neo-adjuvant chemotherapy

Ilhan Tasdöven et al. Breast J. 2020 Sep.

Abstract

Margin status is one of the significant prognostic factors for recurrence in breast-conserving surgery (BCS). The issue that merits consideration for oncologic safety and cost-effectiveness about the modalities to assure clear margins at initial surgical intervention remains controversial after neo-adjuvant chemotherapy (NAC). The presented study aimed to assess the impact of intraoperative ultrasound (IOUS)-guided surgery on accurate localization of tumor site, adequacy of excision with clear margins, and healthy tissue sacrifice in BCS after NAC. Patients who had IOUS-guided BCS ater NAC were reviewed. No patient had preoperative localization with wire or radiotracer. Intraoperative real-time sonographic localization, sonographic margin assessment during resection, macroscopic and sonographic examination of specimen, and cavity shavings (CS) were done as the standard procedure. No frozen assessment was performed. One hundred ninety-four patients were included, in which 42.5% had pCR. IOUS-guided surgery accomplished successful localization of the targeted lesions in all patients. Per protocol, all inked margins on CS specimens were reported to be tumor-free in permanent histopathology. No re-excision or mastectomy was required. For a setting without CS, the negative predictive value (NPV) of IOUS rate was 96%. IOUS was found to over and underestimate tumor response to NAC both in 2% of patients. IOUS-guided surgery seems to be an efficient modality to perform adequate BCS after NAC with no additional localization method. Especially, when CS is integrated as a standard to BCS, IOUS seems to provide safe surgery for patients with no false negativity and a high rate of NPV.

Keywords: breast‐conserving surgery; intraoperative ultrasonography; neo‐adjuvant chemotherapy.

PubMed Disclaimer

References

REFERENCES

    1. Morrow M. De‐escalating and escalating surgery in the management of early breast cancer. Breast. 2017;34(Suppl 1):S1‐S4.
    1. Mamtani A, Barrio AV, King TA, et al. How often does neoadjuvant chemotherapy avoid axillary dissection in patients with histologically confirmed nodal metastases? Results of a prospective study. Ann Surg Oncol. 2016;23(11):3467‐3474.
    1. von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2‐positive breast cancer. N Engl J Med. 2019;380(7):617‐628.
    1. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology‐American Society for Radiation Oncology consensus guideline on margins for breast‐conserving surgery with whole‐breast irradiation in stages I‐II invasive breast cancer. Ann Surg Oncol. 2014;3:704‐716.
    1. Landercasper J, Whitacre E, Degnim AC, et al. Reasons for re‐excision after lumpectomy for breast cancer: insight from The American Society of Breast Surgeons Masterysm Database. Ann Surg Oncol. 2014;21(10):3185‐3191.

LinkOut - more resources