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Open Access 01-01-2016 | Breast Oncology

Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT)

Authors: Max H. Haloua, MD, José H. Volders, MD, Nicole M. A. Krekel, MD, PhD, Alexander M. F. Lopes Cardozo, MD, Wifred K. de Roos, MD, PhD, Louise M. de Widt-Levert, MD, Henk van der Veen, MD, Herman Rijna, MD, PhD, Elisabeth Bergers, MD, Katarzyna Jóźwiak, PhD, Prof. Sybren Meijer, MD, PhD, M. Petrousjka van den Tol, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2016

Abstract

Background

Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial).

Objective

The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS).

Methods

A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either USS (65 patients) or PGS (69 patients). Cosmetic outcomes were assessed by a three-member panel using computerized software Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and by patient self-evaluation, including patient satisfaction. Time points for follow-up were 3, 6, and 12 months after surgery. Overall cosmetic outcome and patient satisfaction were scored on a 4-point Likert scale (excellent, good, fair, or poor), and outcomes were analyzed using a multilevel, mixed effect, proportional odds model for ordinal responses.

Results

Ultrasound-guided breast-conserving surgery achieved better cosmetic outcomes, with 20 % excellence overall and only 6 % rated as poor, whereas 14 % of PGS outcomes were rated excellent and 13 % as poor. USS also had consistently lower odds for worse cosmetic outcomes (odds ratio 0.55, p = 0.067) than PGS. The chance of having a worse outcome was significantly increased by a larger lumpectomy volume (p _trend = 0.002); a volume >40 cc showed odds 2.78-fold higher for a worse outcome than a volume ≤40 cc. USS resulted in higher patient satisfaction compared with PGS.

Conclusion

Ultrasound-guided breast-conserving surgery achieved better overall cosmetic outcomes and patient satisfaction than PGS. Lumpectomy volumes >40 cc resulted in significantly worse cosmetic outcomes.

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Title: Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT)
Authors: Max H. Haloua, MD
José H. Volders, MD
Nicole M. A. Krekel, MD, PhD
Alexander M. F. Lopes Cardozo, MD
Wifred K. de Roos, MD, PhD
Louise M. de Widt-Levert, MD
Henk van der Veen, MD
Herman Rijna, MD, PhD
Elisabeth Bergers, MD
Katarzyna Jóźwiak, PhD
Prof. Sybren Meijer, MD, PhD
M. Petrousjka van den Tol, MD, PhD
Publication date: 01-01-2016
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 1/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4906-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT)

Abstract

Background

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

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