Intraoperative Ultrasound and Oncoplastic Combined Approach: An Additional Tool for the Oncoplastic Surgeon to Obtain Tumor-Free Margins in Breast Conservative Surgery—A 2-Year Single-Center Prospective Study |
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| Institution: | 1. Unità di Oncologia Chirurgica Ricostruttiva della Mammella, “Spedali Riuniti” di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia;2. Department of Surgery “P. Valdoni,” Unit of Plastic and Reconstructive Surgery, “Sapienza” University of Rome, Rome, Italy;3. Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy;1. Cell Biology and Histology, Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt;2. Medical Biochemistry and Molecular Biology, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt;3. Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt;4. Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt;5. Tissue Culture and Cytogenetics Unit, Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt;1. Department of Radiation Oncology, Boston Medical Center, Boston, MA;2. Department of Hematology Oncology, Boston Medical Center, Boston, MA;3. Department of Surgery, Boston Medical Center, Boston, MA;4. Present affiliation: Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA;1. Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China;2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China;1. Department of Pathology, the Second Affiliated Hospital of Jinan University, Shenzhen People’s Hospital, Shenzhen, China;2. Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong;3. Department of Pathology, Kwong Wah Hospital, Yaumatei, Hong Kong;4. Department of Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong;5. Department of Breast Surgery, the Second Affiliated Hospital of Jinan University, Shenzhen People’s Hospital, Shenzhen, China;1. Department of Medical Education, Faculty of Medicine, Biruni University, Istanbul, Turkey;2. Department of Food Engineering, Laboratory of Nutrigenomics and Epidemiology, Izmir Institute of Technology, Izmir, Turkey;3. Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul, Turkey;4. Breast Center, Istanbul Oncology Hospital, Istanbul, Turkey;5. Department of Nuclear Medicine, Neolife Medical Center, Istanbul, Turkey;6. Breast Surgical Oncology, Dana Farber/Brigham Women''s Cancer Center, Boston, MA;7. Breast Center, Memorial Bahcelievler Hospital, Istanbul, Turkey |
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| Abstract: | BackgroundThe 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 MethodsBetween 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.ResultsAll 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.ConclusionIOUS represent an additional tool for the breast surgeon to improve margin-free management of neoplastic lesions, preventing reoperations in patients undergoing oncoplastic surgery. |
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| Keywords: | Breast cancer Intraoperative ultrasound (IOUS) Oncoplastic breast-conserving surgery (OBCS) Oncoplastic surgery Tumor free margins |
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