Intraoperative ultrasound guidance in breast-conserving surgery shows superiority in oncological outcome, long-term cosmetic and patient-reported outcomes

Volders, José H.; Haloua, M.H.; Krekel, N.M.A.; Negenborn, Vera L.; Kolk, Roos H. E.; Cardozo, A.; Bosch, Anne Marie; Widt-Levert, Louise M. de; Veen, H. van der; Rijna, Herman; Amerongen, Annette H. M. Taets van; Jóźwiak, Katarzyna; Meijer, Sybren; Tol, M. Petrousjka van den

doi:10.1016/j.ejso.2016.11.004

Cited by 41 publications

(38 citation statements)

References 28 publications

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“…Our results establish beyond dispute the strong correlation between the perception of cosmetic outcome and feelings of satisfaction in breast cancer patients. However, 11.8% of patients are satisfied despite a fair or poor cosmetic outcome, an incongruity which is also observed in many other studies . This discordance in favor of satisfaction might be related to prior expectations, with some patients perhaps not expecting that the treated breast will remain unchanged.…”

Section: Discussionmentioning

confidence: 78%

Breast‐specific factors determine cosmetic outcome and patient satisfaction after breast‐conserving therapy: Results from the randomized COBALT study

Volders

Negenborn

Haloua

et al. 2018

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 78%

Breast‐specific factors determine cosmetic outcome and patient satisfaction after breast‐conserving therapy: Results from the randomized COBALT study

Volders

Negenborn

Haloua

et al. 2018

Journal of Surgical Oncology

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“…Since microcalcifications are hardly visible on US, their localization without the aid of a US‐visible clip is often under stereotactic guidance, with subsequent limitations . Conversely, TCC allowed to exactly recognize microcalcifications on US, and preoperative US localization was extremely accurate also thanks to the knowledge of the depth distance between the skin and TCC, thus providing the three coordinates of TCC position and overcoming the lacking of an intraoperative guide offered by ROLL . Furthermore, an intraoperative X‐ray of specimen was always performed in TCC patients to confirm clip retrieval, allowing to immediately check the position of the lesion within the specimen.…”

Section: Discussionmentioning

confidence: 99%

Radio‐guided and clip‐guided preoperative localization for malignant microcalcifications offer similar performances in breast‐conserving surgery

et al. 2019

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Obtaining a tailored breast resection is challenging in microcalcifications detected on screening mammography, and an accurate localization is required. The aim of this study was to compare the efficacy of radio‐guided localization (ROLL) versus ultrasound localization of a titanium clip with collagen (TCC) in terms of clear margins, re‐intervention rates, excess of resected breast tissue, and operative times in pure malignant microcalcifications detected on screening mammography. Two hundred and twenty‐one consecutive patients with malignant microcalcifications detected on screening mammography from a tertiary breast unit were reviewed: 177 patients were localized by TCC and 44 patients by stereotactic ROLL. A propensity score‐matched analysis was performed, followed by a logistic regression model, to avoid selection bias. Adequacy of resection was expressed as the calculated resection ratio considering lesion size. No differences were found in clear margins with ROLL versus TCC (77.3% vs 81.8%, adjusted OR 2, P = 0.27). Re‐operation rates were similar, being 11.3% with ROLL and 7.4% with TCC (P = 0.627). Mean resection volume was 46.2 cm3 with ROLL versus 54.2 cm3 with TCC (P = 0.222). Adjusted mean calculated resection ratio was 1.8 with ROLL and 2.1 with TCC (P = 0.38). Surgery time was longer with TCC compared to ROLL (69.6 vs 52.7 minutes, P < 0.0001). ROLL and TCC are equally effective to excise malignant microcalcifications with clear margins, providing similar re‐intervention rates and resection volumes.

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“…Despite this tendency and the higher proportion of patients with EIC (34.9% vs 20.3%; P = 0.031), ROLL allowed a more tailored surgery compared with TCC, and standardization of surgery thanks to ROLL was demonstrated by the lower dispersion of mean CRR ( P = 0.0002). Indeed, intraoperative guiding with ROLL, by continuously checking with the probe the position of the lesion, allowed to tailor the resection in real‐time, conversely to TCC‐guided surgery …”

Section: Discussionmentioning

confidence: 99%

“…Indeed, intraoperative guiding with ROLL, by continuously checking with the probe the position of the lesion, allowed to tailor the resection in real-time, conversely to TCC-guided surgery. 24,25 No difference was observed in oncologic outcomes between ROLL and TCC patients, and in particular loco-regional recurrences were less frequent among ROLL patients (1.9% vs 3.2%; P = 0.628), despite their lower volumes of resection. Thus, TCC-guided surgery was associated with excessive breast resections without a benefit in loco-regional control.…”

Section: Mass-like Lesions Such As Nodules or Distortions Have Been Omentioning

confidence: 96%

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

Corsi

Bossi

Combi

et al. 2019

Journal of Surgical Oncology

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Background and Objectives An accurate localization is mandatory to tailor breast lumpectomy in nonpalpable cancers. The aim of this study was to compare radio‐guided localization (ROLL) vs ultrasound localization of a titanium clip with collagen (TCC) in nonpalpable mass‐like breast cancers. Methods Two hundred seventy‐three consecutive patients were reviewed: 64 patients were localized by TCC and 209 patients by ROLL. Propensity score‐matched analysis was performed. Margin status and reintervention rates were compared. Adequacy of resection was expressed as the calculated resection ratio (CRR) considering lesion size. Loco‐regional and distant recurrence rates were assessed with ROLL vs TCC. Results No differences were found with ROLL vs TCC in clear margins (90.6% vs 89.1%; odds ratio, 0.74; P = 0.64) or reoperations (6.7% vs 1.6%; P = 0.529). ROLL allowed more tailored resections compared with TCC (adjusted CRR, 1.7 vs 2.7; P = 0.0008), particularly in lesions with associated extensive intraductal component (CRR, 3.0 vs 4.5; P = 0.017). Loco‐regional recurrence occurred in 1.9% of ROLL patients vs 3.2% of TCC cases (P = 0.628). Conclusions ROLL and TCC are equally effective to excise nonpalpable mass‐like breast cancers with clear margins, providing similar loco‐regional control. However, ROLL allows more tailored breast resections, particularly in lesions with the associated extensive intraductal component.

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Intraoperative ultrasound guidance in breast-conserving surgery shows superiority in oncological outcome, long-term cosmetic and patient-reported outcomes

Cited by 41 publications

References 28 publications

Breast‐specific factors determine cosmetic outcome and patient satisfaction after breast‐conserving therapy: Results from the randomized COBALT study

Breast‐specific factors determine cosmetic outcome and patient satisfaction after breast‐conserving therapy: Results from the randomized COBALT study

Radio‐guided and clip‐guided preoperative localization for malignant microcalcifications offer similar performances in breast‐conserving surgery

Radio‐guided vs clip‐guided localization of nonpalpable mass‐like lesions of the breast from a screened population: A propensity score‐matched study

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