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Resection Margins in Ultrasound-Guided Breast-Conserving Surgery

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel

    Oded Olsha MB, BS, David Shemesh MD, Moshe Carmon MD, Ribhi Abu Dalo MD & Louis Rivkin MD

  2. Department of Surgery, Bikur Cholim Hospital, Jerusalem, Israel

    Ohn Sibirsky MD

  3. Department of Surgery B, Hillel Yaffe Medical Center, Hadera, Israel

    Itamar Ashkenazi MD

Authors
  1. Oded Olsha MB, BS
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  2. David Shemesh MD
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  3. Moshe Carmon MD
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  4. Ohn Sibirsky MD
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  5. Ribhi Abu Dalo MD
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  6. Louis Rivkin MD
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  7. Itamar Ashkenazi MD
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Correspondence to Oded Olsha MB, BS.

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Olsha, O., Shemesh, D., Carmon, M. et al. Resection Margins in Ultrasound-Guided Breast-Conserving Surgery. Ann Surg Oncol 18, 447–452 (2011). https://doi.org/10.1245/s10434-010-1280-0

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  • DOI: https://doi.org/10.1245/s10434-010-1280-0

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