title: Intraoperative ultrasound versus mammographic needle localization for ductal carcinoma in situ.
abstract: BACKGROUND
  Ductal carcinoma in situ (DCIS) often requires some method of localization to achieve breast-conserving therapy. The purpose of this study was to compare the efficacy of intraoperative ultrasound versus mammographic needle localization (MNL) for partial mastectomy in DCIS.
  
  
  METHODS
  Data were collected from a Breast Cancer Surgery Database. All DCIS cases undergoing partial mastectomy (PM) were identified. Margin status, re-excision rates, and cost were determined for both groups.
  
  
  RESULTS
  A total of 155 patients undergoing PM for DCIS were identified from the database. In the 96 patients undergoing ultrasound-guided PM (Group 1), the positive margin rate was 10.4%, and close margins (<1 mm) were observed in 22.9% after initial surgery. There were 59 patients who underwent MNL (Group 2); the positive margin rate was 11.9%, and close margins were observed in 27.1%. The difference between positive and close margins in Group 1 versus Group 2 was not statistically significant. The rate of re-excision was 20.8% for Group 1 and 30.5% for Group 2, resulting in 1.23 and 1.37 operations per patient, respectively. The average cost of an intraoperative ultrasound at our institution was $933 and $1858 for MNL (excluding cost of radiologic interpretation), a difference of $925 per case.
  
  
  CONCLUSIONS
  Our study showed equivalent rates of positive margins and re-excision between intraoperative ultrasound and MNL when performing PM for nonpalpable DCIS. Considering the more invasive nature and increased cost of MNL, we consider surgeon-performed intraoperative ultrasound, when possible, the more cost-effective and practical procedure for patients with DCIS.
authors.affiliation: Department of Surgery, University of Vermont, Burlington, VT, USA. ted.james@uvm.edu
authors.forename: T A
authors.initials: TA
authors.lastname: James
authors.forename: S
authors.initials: S
authors.lastname: Harlow
authors.forename: J
authors.initials: J
authors.lastname: Sheehey-Jones
authors.forename: M
authors.initials: M
authors.lastname: Hart
authors.forename: C
authors.initials: C
authors.lastname: Gaspari
authors.forename: M
authors.initials: M
authors.lastname: Stanley
authors.forename: D
authors.initials: D
authors.lastname: Krag
authors.forename: Takamaru
authors.initials: T
authors.lastname: Ashikaga
authors.forename: L E
authors.initials: LE
authors.lastname: McCahill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008327:Mammography / Q000379:methods*; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009339:Needles; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary / Q000379:methods*