Learning curves in intraoperative ultrasound guided surgery in breast cancer based on complete breast cancer excision and no need for second surgeries |
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| Institution: | 1. Breast Cancer Surgical Unit, Clínica Universidad de Navarra, Madrid, Spain;2. Breast Cancer Surgical Unit, Hospital Universitario Vall d’Hebrón, Barcelona, Spain;3. Department of Radiology, Breast Imaging, Hospital Universitario Vall d’Hebrón, Barcelona, Spain;1. Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European, Hospital, Paris, France;2. URDIA Anatomy EA 4465 UFR Biomédicale des Saints-Pères, Paris, France;3. Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France;4. Gynecology Department, University Hospital, University of Lausanne, Lausanne, Switzerland;5. Hospices Civils de Lyon, Pôle IMER, Lyon, F-69003, France;6. Obstetrics and Gynecology Department, Poissy UMC, France;1. Dept. of Surgical Oncology, Zydus Hospital, Ahmedabad, India;2. Dept. of Surgical Oncology, Jehangir Hospital, Pune, India;3. Dept. of Surgical Oncology, Saifee Hospital, Mumbai, India;4. Dept. of Surgical Oncology, MVR Cancer Center and Research Institute, Calicut, India;5. Dept. of Surgical Oncology, Manipal Hospital, Bangalore, India;6. Dept. of Surgical Oncology, Global Hospital, Hyderabad, India;7. Dept. of Pathology, Fortis Hospital, Bangalore, India;8. Dept. of Pathology, Zydus Hospital, Ahmedabad, India;9. Dept. of Gynecological Oncology, Mazumdar Shaw Cancer Center, Bangalore, India;10. Dept. of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India;11. Dept. of Surgical Oncology, Kovai Medical Center, Coimbatore, India;1. Breast Surgery Unit, San Raffaele Hospital, Milan, Italy;2. Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy;3. School of Medicine, Vita-Salute University, Milan, Italy;4. Breast Radiology Unit, San Raffaele Hospital, Milan, Italy;5. Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy;6. Radiotherapy Unit, San Raffaele Hospital, Milan, Italy;7. Pathology Unit, San Raffaele Hospital, Milan, Italy;8. Breast Oncology Unit, San Raffaele Hospital, Milan, Italy |
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| Abstract: | BackgroundIntraoperative ultrasound guided surgery (IOUS) is an effective surgical technique for breast cancer with advantages over wire localization guided surgery (WL), enabling smaller lumpectomies without compromising margins. Nevertheless, it has had a slow implementation, maybe due to lacking a learning curve. Also differences in costs are not clearly reported. The aim of the study is to assess differences in volume of healthy breast tissue excised, to establish a learning curve and to prove it is cost saving.Patients and methodsFrom February 2009 to April 2013, women diagnosed with invasive breast cancer eligible for IOUS or WL breast conserving surgery were recorded into a prospectively maintained database. Both groups were compared for differences in margin status, second surgeries and excess of healthy tissue resected, defined by the calculated resection ratio (CRR). A raw cost study was assessed. IOUS learning curve was analyzed using Cumulative sum control chart (CUSUM).ResultsThe study included 214 patients, 148 (69.16%) in the IOUS group and 66 (30.84%) in the WL group. IOUS showed significantly smaller surgical volumes (p = 0.02), smaller CRR (p = 0.006), higher rate of negative margins (p = 0.017) and less surgical time (p = 0.006) than WL. Learning curves based on complete tumor excision and no need for second surgeries showed that 11 cases were enough to master the technique. Around 900€ per surgery was saved using IOUS vs. WL.ConclusionIOUS decreases excision of healthy breast tissue while increasing negative margin rates compared to WL. IOUS can be easily implemented; 11 cases are enough to acquire skills for performing the technique. Savings can be up to 900€ per surgery. |
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| Keywords: | Breast cancer Cost study Margins Wire localization Ultrasound guided surgery Learning curve |
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