Intra-operative sonography: a valuable aid during breast-conserving surgery for occult breast cancer.
BACKGROUND
Breast cancer is increasingly detected during an early non-palpable stage. Together with pre-operative marking of the mass, intra-operative imaging provides invaluable clues. This study was designed to evaluate the usefulness of intra-operative sonography in the hands of the surgeon.


METHODS
Between July 2001 and October 2006, 567 patients underwent treatment for operable breast cancer at the landeskrankenhaus (LHK) Feldkirch. Three hundred and sixty lesions were not palpable. Two hundred and ninety-nine patients with poorly definable or non-definable lesions well seen by ultrasound imaging underwent intra-operative sonography (group 1), while 61 patients with non-palpable lesions only seen on mammography (group 2) were subjected to pre-operative needle localization. The study was non-randomized with prospective data acquisition


RESULTS
All lesions were identified by both sonography and pre-operative needle localization. In the ultrasound group (group 1) 81% of the lesions were successfully removed by primary intention without metachronous secondary surgery versus 62% in group 2 (p < 0.00228). Eighty-eight percent of the lesions in group 1 were eligible for breast-conserving surgery versus 75% in group 2. The mean clear margin in group 1 was substantially smaller (4.8 mm) than in group 2 (7.2 mm) (p < 0.0001).


CONCLUSIONS
Intra-operative sonography proved to be a reliable and helpful tool in the hands of the surgeon, not only for tumor localization, but also for orientation during tumor excision. It simplifies organizational work and spares the patient the discomfort of pre-operative needle localization.
Haid
Anton
A
Department of General and Thoracic Surgery, Landeskrankenhaus Feldkirch, Teaching Hospital of Innsbruck University, Carinagasse 47-49, 6800, Feldkirch, Austria. anton.haid@cable.vol.at
Knauer
Michael
M
Dunzinger
Stephanie
S
Jasarevic
Zerina
Z
Köberle-Wührer
Roswitha
R
Schuster
Antonius
A
Toeppker
Michael
M
Haid
Bernhard
B
Wenzl
Etienne
E
Offner
Felix
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging* / Q000601:surgery; D002454:Cell Differentiation; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008327:Mammography; D015412:Mastectomy, Segmental; D008499:Medical Records; D008875:Middle Aged; D010173:Palpation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography