Ultrasound-guided surgery is the way to go for optimal breast tumor removal

According to the results of a randomised trial presented at this years’ European Breast Cancer Congress (EBCC), the use of ultrasound-guided surgery for the removal of tumors from women with palpable breast cancer is much more successful than standard surgery in excising all the cancerous tissue, while sparing as much healthy tissue as possible. Using this technique, breast surgeons were able to remove 96.7% of all palpable tumors with adequate tumor free margins. Furthermore, the unnecessary resection of healthy tissue was significantly reduced.

Breast-conserving surgery is generally performed with the guidance from the surgeons’ palpation only, without the help of intra-operative tumor localisation techniques. Unfortunately, this technique is associated with a high rate of positive excision margins as well as the excision of excessively large volumes of healthy tissue. Previous studies have shown benefits for ultrasound-guided surgery over wire-localisation in non-palpable tumors, but little research has been done in the use of ultrasound-guided surgery for palpable tumors. In this light, 124 eligible patients with palpable T1-T2 invasive breast cancer were randomised to either ultrasound-guided surgery (USS), or palpation-guided surgery (PGS).

Among the 61 women in the USS group, only 3.3% of the margins contained cancerous cells, compared with 16.4% among the 63 women treated with PGS. As a result, USS was associated with a significant reduction in the number of re-excisions, mastectomies and irradiation boosts compared to PGS. Furthermore, the excision volumes were significantly smaller with USS compared to PGS (40 cubic centimeters vs. 58 cubic centimeters; p<0.05). By measuring the volume of the tissue excised during surgery and the actual tumor diameters, the researchers calculated the excess of healthy tissue that had been removed, resulting in a ‘calculated resection ratio’ (CRR). A CRR of 1.0 would indicate that the ideal amount of tissue had been removed, while a CRR of 2 would mean that double the amount necessary had been excised. The study showed that USS was associated with an optimal CRR of 1.0, while the PGS group had a median CRR of 1.9 (p<0.05).

These results clearly show that USS can prevent the unacceptably high rate of margins containing cancer cells in palpable breast cancer excision, thus avoiding additional surgery or radiation. Furthermore, USS largely reduces the amount of unnecessary removed healthy tissue, thereby contributing to the improvement of cosmetic results. Although the implications of these data are huge, one needs to acknowledge that this is only a report of a single hospital and that these finding need confirmation from other teams of surgeons. Nevertheless, USS offers the promise of more successful breast conserving surgery for women with early breast cancer.

Reference
Krekel et al. Intra-operative ultrasound is imperative to obtain adequate tumor margins and excision volumes in breast-conserving surgery for palpable breast cancer: Results of a randomised controlled trial. Presented at EBCC 2012. Abstract 1LBA.