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01-02-2011 | Breast Oncology

Resection Margins in Ultrasound-Guided Breast-Conserving Surgery

Authors: Oded Olsha, MB, BS, David Shemesh, MD, Moshe Carmon, MD, Ohn Sibirsky, MD, Ribhi Abu Dalo, MD, Louis Rivkin, MD, Itamar Ashkenazi, MD

Published in: Annals of Surgical Oncology | Issue 2/2011

Abstract

Background

Few published studies have shown the benefits of intraoperative ultrasound in avoiding inadequate margins in breast-conserving surgery. The aim of this study is to quantify intraoperative ultrasound margin size and assess its relationship to tumor size, multifocality, palpability, histology, and presence of intraductal component.

Methods

Patients with breast cancer undergoing breast-conserving surgery in whom the operating surgeon visualized the tumor by ultrasound were included. Ultrasound margins measured intraoperatively were prospectively recorded and compared with pathology margins.

Results

Forty-five patients with 48 tumors were included. Twenty five patients (56%) had palpable tumors. Pathologic mean tumor size was 1.9 cm [95% confidence interval (CI) 1.6–2.2 cm, range 0.5–4.8 cm]. There was good correlation between closest margins recorded by ultrasound and pathology margins (r = 0.4674, P < 0.0008). Fourteen patients (31%) had margins re-excised intraoperatively, 12 of them in the direction of the closest pathological margin. Three patients (7%), all of whom had intraoperative re-excision, had a second operation for involved margins without residual cancer on pathological examination of the reoperative specimens. Ultrasound margins ≥0.5 cm achieved adequate pathology margins of ≥0.2 cm in 95% of margins. Overestimation of pathology margins by ultrasound measurement was significantly affected by multifocality (P = 0.0473). Tumor size, palpability, invasive lobular histology, and presence of ductal carcinoma in situ (DCIS) did not cause significant overestimation of pathology margins by ultrasound.

Conclusions

Intraoperative ultrasound may help maintain a low level of reoperation after breast-conserving surgery. Ultrasound margins <0.5 cm should be re-excised intraoperatively. Reliability of ultrasound in predicting the closest pathology margins was diminished in patients with multifocal tumors.

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Title: Resection Margins in Ultrasound-Guided Breast-Conserving Surgery
Authors: Oded Olsha, MB, BS
David Shemesh, MD
Moshe Carmon, MD
Ohn Sibirsky, MD
Ribhi Abu Dalo, MD
Louis Rivkin, MD
Itamar Ashkenazi, MD
Publication date: 01-02-2011
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 2/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-010-1280-0

At a glance: The STEP trials

Springer Medicine

Resection Margins in Ultrasound-Guided Breast-Conserving Surgery

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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