Intraoperative ultrasound localization of nonpalpable breast cancers.
BACKGROUND
Preoperative localization of nonpalpable breast cancers requires good coordination between imaging and surgery departments, and insertion of a guide wire can be traumatic for the patient. This study was designed to evaluate the efficacy of intraoperative ultrasound localization of nonpalpable breast cancers directly by the surgeon.


METHODS
This prospective study was conducted from June 2006 to October 2006 in 70 patients who underwent surgery for nonpalpable invasive breast cancer. Ultrasound was performed in the operating room by the surgeon with the patient in the operative position. Tumor identification, the correlation with tumor diameter on preoperative ultrasound, analysis of resection margins, and the need to perform surgical re-excision were analyzed.


RESULTS
Intraoperative ultrasound identified the target in 67 (95.7%) of 70 patients. Two of the three lesions not detected by intraoperative ultrasound were < or =5 mm in diameter in patients with a body mass index of > or =25 (normal range, 19-24). The correlation with diagnostic ultrasound for tumor dimensions was satisfactory (correlation coefficient r = .80). Resection margins free of invasive lesions were obtained in 66 cases (94.3%). Three patients (4.3%) required surgical re-excision, one mastectomy due to multifocal cancer, and two lumpectomy due to positive resection margins.


CONCLUSIONS
Intraoperative ultrasound localization of nonpalpable breast cancers is feasible and effective, with a sensitivity of 98.3% for tumors >5 mm. It spares the patient the discomfort of a radiological and/or supplementary examination with insertion of a guide wire. It also saves time and money for hospital teams.
Ngô
Charlotte
C
Department of General Surgery, Institut Curie, 26 Rue D'ulm, Paris, France.
Pollet
Aymeric G
AG
Laperrelle
Juliette
J
Ackerman
Gregory
G
Gomme
Sandra
S
Thibault
Fabienne
F
Fourchotte
Virginie
V
Salmon
Remy J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D012086:Reoperation; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary