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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2009

01-05-2009 | Breast Oncology

Intraoperative Ultrasound Versus Mammographic Needle Localization for Ductal Carcinoma In Situ

Authors: T. A. James, MD, S. Harlow, J. Sheehey-Jones, M. Hart, C. Gaspari, M. Stanley, D. Krag, Takamaru Ashikaga, L. E. McCahill

Published in: Annals of Surgical Oncology | Issue 5/2009

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Abstract

Background

Ductal carcinoma in situ (DCIS) often requires some method of localization to achieve breast-conserving therapy. The purpose of this study was to compare the efficacy of intraoperative ultrasound versus mammographic needle localization (MNL) for partial mastectomy in DCIS.

Materials and Methods

Data were collected from a Breast Cancer Surgery Database. All DCIS cases undergoing partial mastectomy (PM) were identified. Margin status, re-excision rates, and cost were determined for both groups.

Results

A total of 155 patients undergoing PM for DCIS were identified from the database. In the 96 patients undergoing ultrasound-guided PM (Group 1), the positive margin rate was 10.4%, and close margins (<1 mm) were observed in 22.9% after initial surgery. There were 59 patients who underwent MNL (Group 2); the positive margin rate was 11.9%, and close margins were observed in 27.1%. The difference between positive and close margins in Group 1 versus Group 2 was not statistically significant. The rate of re-excision was 20.8% for Group 1 and 30.5% for Group 2, resulting in 1.23 and 1.37 operations per patient, respectively. The average cost of an intraoperative ultrasound at our institution was $933 and $1858 for MNL (excluding cost of radiologic interpretation), a difference of $925 per case.

Conclusion

Our study showed equivalent rates of positive margins and re-excision between intraoperative ultrasound and MNL when performing PM for nonpalpable DCIS. Considering the more invasive nature and increased cost of MNL, we consider surgeon-performed intraoperative ultrasound, when possible, the more cost-effective and practical procedure for patients with DCIS.
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Metadata
Title
Intraoperative Ultrasound Versus Mammographic Needle Localization for Ductal Carcinoma In Situ
Authors
T. A. James, MD
S. Harlow
J. Sheehey-Jones
M. Hart
C. Gaspari
M. Stanley
D. Krag
Takamaru Ashikaga
L. E. McCahill
Publication date
01-05-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0388-6

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