Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2018

01-10-2018 | Breast Oncology

Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy

Authors: Amelia Y. Merrill, MD, MPH, Daniela Ochoa, MD, V. Suzanne Klimberg, MD, PhD, Erica L. Hill, DO, Michael Preston, PhD, MPH, Kristen Neisler, MS, Ronda S. Henry-Tillman, MD

Published in: Annals of Surgical Oncology | Issue 10/2018

Login to get access

Abstract

Background

Localization of nonpalpable breast lesions for breast-conserving surgery (BCS) remains highly variable and includes needle/wire localization (NL), radioactive seed localization, radar localization, and hematoma-directed ultrasound-guided (HUG) lumpectomy. The superiority of HUG lumpectomy over NL has been demonstrated repeatedly in terms of safety, accuracy, low positive margin rates, cosmesis, and patient satisfaction. In this study, we evaluate the cost effectiveness of HUG lumpectomy over NL for nonpalpable breast lesions.

Methods

We performed a retrospective review of 569 patients who underwent lumpectomy at the University of Arkansas for Medical Sciences from May 2014 through December 2017. Lumpectomies were stratified by localization technique, i.e. NL versus HUG. A cost-savings estimate was determined for the HUG localization technique, and a total amount of dollars saved over the study period was calculated.

Results

Overall, 569 lumpectomies were performed: 501 (88.0%) via HUG and 68 (12.0%) via NL. Intraoperative ultrasound was used in 566 operations (99.5%). Of the lumpectomies performed by HUG, 190 lesions (33.4%) were visible only on mammogram or breast magnetic resonance imaging prior to diagnostic core needle biopsy (CNB). Cost estimates comparing HUG with NL demonstrated a cost savings of $497.00 per procedure, the cost of preoperative needle localization by a radiologist, and a total of $94,430.00 for the study period.

Conclusion

In utilizing HUG lumpectomy, the initial CNB serves as the diagnostic and localization procedure, thus saving time and a painful second procedure on the day of operation. HUG lumpectomy is safe, accurate, reduces healthcare costs, and results in a better patient experience for the surgical removal of nonpalpable breast lesions.
Literature
1.
Snider HC, Morrison DG. Intraoperative ultrasound localization of nonpalpable breast lesions. Ann Surg Oncol. 1999;6:308–14.CrossRefPubMed
2.
Paramo JC, Landeros M, McPhee MD, Mesko TW. Intraoperative ultrasound-guided excision of nonpalpable breast lesions. Breast J. 1999;5:389–94.CrossRefPubMed
3.
Rahusen FD, Taets van Amerongen AH, van Diest PJ, Borgstein PJ, Bleichrodt RP, Meijer S. Ultrasound-guided lumpectomy of nonpalpable breast cancers: a feasibility study looking at the accuracy of obtained margins. J Surg Oncol. 1999;72:72–6.CrossRefPubMed
4.
Bennett IC, Greenslade J, Chiam H. Intraoperative ultrasound-guided excision of nonpalpable breast lesions. World J Surg. 2005;29:369–74.CrossRefPubMed
5.
Thompson M, Henry-Tillman R, Margulies A, et al. Hematoma-directed ultrasound-guided (HUG) breast lumpectomy. Ann Surg Oncol. 2007;14:148–56.CrossRefPubMed
6.
Rahman RL, Crawford S, Larkin A, Quinlan R. Superiority of sonographic hematoma guided resection of mammogram only visible breast cancer: wire localization should be an exception—not the rule. Ann Surg Oncol. 2007;14:2228–32.CrossRef
7.
Haid A, Knauer M, Dunzinger S, et al. Intra-operative sonography: a valuable aid during breast-conserving surgery for occult breast cancer. Ann Surg Oncol. 2007;14:3090–101.CrossRefPubMed
8.
Haloua MH, Krekel NM, Coupé VM, Bosmans JE, Lopes Cardozo AM, Meijer S, et al. Ultrasound-guided surgery for palpable breast cancer is cost-saving: results of a cost-benefit analysis. Breast. 2013;22:238–43.CrossRefPubMed
9.
Yu CC, Chiang KC, Kuo WL, Shen SC, Lo YF, Chen SC. Low re-excision rate for positive margins in patients treated with ultrasound-guided breast-conserving surgery. Breast. 2013;22:698–702.CrossRefPubMed
10.
Krekel NM, Haloua MH, Lopes Cardozo AM, et al. Intraoperative ultrasound guidance for palpable breast cancer excision (COBOALT trial): a multicenter, randomised controlled trial. Lancet Oncol. 2013;14:48–54.CrossRefPubMed
11.
Haloua MH, Volders JH, Krekel NM, et al. Intraoperative ultrasound guidance in breast-conserving surgery improves cosmetic outcomes and patient satisfaction: results of a multicenter randomized controlled trial (COBALT). Ann Surg Oncol. 2016;23:30–7.CrossRefPubMed
12.
Volders JH, Haloua MH, Krekel NM, Meijer S, van den Tol PM. Current status of ultrasound-guided surgery in the treatment of breast cancer. World J Clin Oncol. 2016;10:44–53.CrossRef
13.
Karadeniz Cakmak G, Emre AU, Tascilar O, Bahadir B, Ozkan S. Surgeon performed continuous intraoperative ultrasound guidance decreases re-excisions and mastectomy rates in breast cancer. Breast. 2017;33:23–8.CrossRefPubMed
14.
15.
Smith LF, Henry-Tillman R, Rubio IT, Korourian S, Klimberg VS. Intraoperative localization after stereotactic breast biopsy without a needle. Am J Surg. 2001;182:584–89.CrossRefPubMed
16.
Klimberg VS. Advances in the diagnosis and excision of breast cancer. Am Surg. 2003;69:11–14.PubMed
17.
18.
Klimberg VS. Intraoperative image-guided breast-conserving surgery should be the gold standard. Ann Surg Oncol. 2016;23:4–5.CrossRefPubMed
19.
Inui H, Watatani M, Hashimoto Y, et al. Hematoma-directed and ultrasound-guided breast conserving surgery for nonpalpable breast cancer after Mammotome biopsy. Surg Today. 2008;38:279–82.CrossRefPubMed
20.
Arentz C, Baxter K, Boneti C, et al. Ten-year experience with hematoma-directed ultrasound-guided (HUG) breast lumpectomy. Ann Surg Oncol. 2010;17:S378–83.CrossRef
21.
Rahusen FD, Bremers AJ, Fabry HF, van Amerongen AH, Boom RP, Meijer S. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial. Ann Surg Oncol. 2002;9:994–8.CrossRefPubMed
22.
James TA, Harlow S, Sheehey-Jones J, et al. Intraoperative ultrasound versus mammographic needle localization for ductal carcinoma in situ. Ann Surg Oncol. 2009;16:1164–9.CrossRefPubMed
23.
Krekel NM, Zonderhuis BM, Stockmann HB, et al. A comparison of three methods for nonpalpable breast cancer excision. Eur J Surg Oncol. 2011;37:109–15.CrossRefPubMed
24.
Barentsz MW, van Dalen T, Gobardhan PD, et al. Intraoperative ultrasound guidance for excision of non-palpable invasive breast cancer; a hospital-based series and an overview of the literature. Breast Cancer Res Treat. 2012;135:209–19.CrossRefPubMed
25.
Pan H, Wu N, Ding H, et al. Intraoperative ultrasound guidance is associated with clear lumpectomy margins for breast cancer: a systematic review and meta-analysis. PLoS ONE. 2013;8:e74028.CrossRefPubMedPubMedCentral
26.
Ahmed M, Douek M. Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancers: systematic review and meta-analysis. Breast Cancer Res Treat. 2013;140:435–46.CrossRefPubMed
27.
Slijkuis WA, Noorda EQ, van der Zaag-Loonen H, Eenennaam MJ, Greve KE, Lastdrager WB, et al. Ultrasound-guided breast-conserving surgery for early-stage palpable and nonpalpable invasive breast cancer: decreased excisional volume at unchanged tumor-free resection margin. Breast Cancer Res Treat. 2016;158:535–41.CrossRef
28.
The American Society of Breast Surgeons. Consensus guideline on concordance assessment of image-guided breast biopsies and management of borderline or high-risk lesions. Columbia, MD: American Society of Breast Surgeons; 2016. p. 1–13.
29.
Henry-Tillman R, Johnson AT, Smith LF, Klimberg VS. Intraoperative ultrasound and other techniques to achieve negative margins. Semin Surg Oncol. 2001;20:206–13.CrossRefPubMed
Metadata
Title
Cutting Healthcare Costs with Hematoma-Directed Ultrasound-Guided Breast Lumpectomy
Authors
Amelia Y. Merrill, MD, MPH
Daniela Ochoa, MD
V. Suzanne Klimberg, MD, PhD
Erica L. Hill, DO
Michael Preston, PhD, MPH
Kristen Neisler, MS
Ronda S. Henry-Tillman, MD
Publication date
01-10-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 10/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6596-1

Other articles of this Issue 10/2018

Annals of Surgical Oncology 10/2018 Go to the issue

Breast Oncology

Effect of Primary Breast Tumor Location on Axillary Nodal Positivity

Breast Oncology

Predicting Post Neoadjuvant Axillary Response Using a Novel Convolutional Neural Network Algorithm

Breast Oncology

Breast Cancer Litigation in the 21st Century

Breast Oncology

Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions

Breast Oncology

Should Reexcision Rates in Breast Cancer Care be a Quality Measure?

Breast Oncology

A Comparison of Patient-Reported Outcomes After Nipple-Sparing Mastectomy and Conventional Mastectomy with Reconstruction