title: Superiority of sonographic hematoma guided resection of mammogram only visible breast cancer: wire localization should be an exception--not the rule.
abstract: BACKGROUND
  The goal of breast conservation in cancer treatment is to obtain adequate margins with minimum tissue loss to achieve acceptable oncologic and cosmetic outcome. The standard for resection of breast cancers visible only on mammogram is wire localization (WL), which has a high rate of positive margins. We hypothesized that sonographic hematoma guided (SHG) resection achieves better margin clearance while minimizing volume of resection by more accurate lesion localization.
  
  
  METHODS
  This retrospective study was conducted at the University Comprehensive Breast Center. Consecutive patients over the span of one year, undergoing breast conservation for stereotactic biopsy proven cancers that were not visualized on ultrasound were studied. SHG and WL technique were compared for age, mammographic abnormality, and tumor characteristics. Outcome variables included closest margin of resection, volume of resection, resection index (resection volume/tumor volume), and rate of margin revision.
  
  
  RESULTS
  Forty-five patients had SHG, while 51 had WL lumpectomy. The SHG and WL groups were similar in age, mammographic abnormality, tumor type, and stage. Median (25th-75th centile) tumor size was larger in SHG group vs WL group [1.2 (1.1-1.3) vs 0.8 (0.4-1.4) cm; P = .009]. Median (25th-75th centile) closest margin in SHG vs WL group was 5.0 (5.0-8.0) vs 4.0 (1.0-10) mm [P = .0041]. Median (25th-75th centile) resection volume in SHG vs WL group was 85.0 (60.0-128.0) vs 142.2 (54.4-229.0) cm(3) [P = .0127]. Median (25th-75th centile) resection index in SHG vs WL group was 77.3 (59.3-285.7) vs 337.1 (88.9-3982.2) [P = .0004]. Margin was revised in 2 (4.4%) SHG vs 8 (15.7%) WL patients [P = .0978].
  
  
  CONCLUSIONS
  Sonographic hematoma guided lumpectomy is superior to wire localization in obtaining adequate margins with minimal volume of resection.
authors.affiliation: UMass Memorial Health Care, Worcester, Massachussetts, USA. layeequr@ummhc.org
authors.forename: Rakhshanda
authors.initials: R
authors.lastname: Layeequr Rahman
authors.forename: Sybil
authors.initials: S
authors.lastname: Crawford
authors.forename: Anne
authors.initials: A
authors.lastname: Larkin
authors.forename: Robert
authors.initials: R
authors.lastname: Quinlan
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden; D016217:Ultrasonography, Mammary