Leonardo Barellini1, Marco Marcasciano2, Federico Lo Torto3, Alfonso Fausto4, Diego Ribuffo3, Donato Casella5. 1. Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia. 2. Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia; Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy. Electronic address: dott.marcomarcasciano@gmail.com. 3. Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy. 4. Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 5. Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia; Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy.
Abstract
BACKGROUND: The main goal of oncoplastic breast-conserving surgery (OBCS) is to obtain tumor-free resection margins after cancer excision with satisfactory cosmetic results. Positive tumor margins are associated with high rates of tumor recurrence requiring reoperation. The aim of this prospective clinical trial was to demonstrate the reliability of intraoperative ultrasound (IOUS) to obtain tumor-free resection margins in OBCS. PATIENTS AND METHODS: Between December 2016 and March 2018, data from 130 patients with by T1-2 breast cancer, either invasive or in situ, who underwent OBCS were prospectively collected. The oncoplastic surgeon performed IOUS in the operating theater to localize the lesion and mark its skin projection. Then specimens were examined to assess the presence of the lesion and margin adequacy. Definitive histologic reports were reviewed, with a focus on margin status. RESULTS: All patients experienced oncoplastic approaches, and lesions were always found on the specimen at the histologic report. In 126 cases (97%), margins were considered adequate. In 17 cases (13%), IOUS showed positive margins, and resection was contextually enlarged. In 12 of these (9%), the pathologic report confirmed the need for enlarged resection. This study shows that IOUS-guided surgery can obtain a high percentage of tumor-free resection margins in OBCS without scheduling conflicts between radiology, nuclear, and surgery departments. Full cooperation between radiologists and oncoplastic surgeons is required to achieve high-standard oncologic and reconstructive outcomes. CONCLUSION: IOUS represent an additional tool for the breast surgeon to improve margin-free management of neoplastic lesions, preventing reoperations in patients undergoing oncoplastic surgery.
BACKGROUND: The main goal of oncoplastic breast-conserving surgery (OBCS) is to obtain tumor-free resection margins after cancer excision with satisfactory cosmetic results. Positive tumor margins are associated with high rates of tumor recurrence requiring reoperation. The aim of this prospective clinical trial was to demonstrate the reliability of intraoperative ultrasound (IOUS) to obtain tumor-free resection margins in OBCS. PATIENTS AND METHODS: Between December 2016 and March 2018, data from 130 patients with by T1-2 breast cancer, either invasive or in situ, who underwent OBCS were prospectively collected. The oncoplastic surgeon performed IOUS in the operating theater to localize the lesion and mark its skin projection. Then specimens were examined to assess the presence of the lesion and margin adequacy. Definitive histologic reports were reviewed, with a focus on margin status. RESULTS: All patients experienced oncoplastic approaches, and lesions were always found on the specimen at the histologic report. In 126 cases (97%), margins were considered adequate. In 17 cases (13%), IOUS showed positive margins, and resection was contextually enlarged. In 12 of these (9%), the pathologic report confirmed the need for enlarged resection. This study shows that IOUS-guided surgery can obtain a high percentage of tumor-free resection margins in OBCS without scheduling conflicts between radiology, nuclear, and surgery departments. Full cooperation between radiologists and oncoplastic surgeons is required to achieve high-standard oncologic and reconstructive outcomes. CONCLUSION: IOUS represent an additional tool for the breast surgeon to improve margin-free management of neoplastic lesions, preventing reoperations in patients undergoing oncoplastic surgery.
Authors: Ekaterina V Gubarkova; Aleksander A Sovetsky; Dmitry A Vorontsov; Pavel A Buday; Marina A Sirotkina; Anton A Plekhanov; Sergey S Kuznetsov; Aleksander L Matveyev; Lev A Matveev; Sergey V Gamayunov; Alexey Y Vorontsov; Vladimir Y Zaitsev; Natalia D Gladkova Journal: Biomed Opt Express Date: 2022-04-21 Impact factor: 3.562