title: Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound--feasibility and surgeons' learning curve.
abstract: OBJECTIVE
  To evaluate if intra-operative guidance with ultrasonography (US) could improve surgical accuracy of palpable breast cancer excision, and to evaluate the performance of surgeons during training for US-guided excision.
  
  
  METHODS
  Thirty female patients undergoing breast-conserving surgery for palpable T1-T2 invasive breast cancer were recruited. Three individual breast surgeons, assisted by US, targeted and excised the tumours. The main objective was to obtain adequate resection margins with optimal resection volumes. The specimen volume, tumour diameter and histological margin status were recorded. The specimen volume was divided by the optimal resection volume, defined as the spherical tumour volume plus a 1.0-cm margin. The resulting calculated resection ratio (CRR) indicated the amount of excess tissue resected.
  
  
  RESULTS
  All tumours were correctly identified during surgery, 29 of 30 tumours (96.7%) were removed with adequately negative margins, and one tumour was removed with focally positive margins. The median CRR was 1.0 (range, 0.4-2.8), implying optimal excision volume. For all breast surgeons, CRR improved during the training period. By the 8th procedure, all surgeons showed proficiency in performing intra-operative breast US.
  
  
  CONCLUSIONS
  Surgeons can easily learn the skills needed to perform intra-operative US for palpable breast tumour excision. The technique is non-invasive, simple, safe and effective for obtaining adequate resection margins. Within the first two cases, resections reached optimal volumes, thereby, presumably resulting in improved cosmetic outcomes. In a multicentre, randomised, clinical trial, intra-operative US guidance for palpable breast tumours will be evaluated for oncological and cosmetic outcomes.
authors.affiliation: Department of Surgical Oncology, VU University Medical Centre, De Boelelaan 1117, Amsterdam, The Netherlands. n.krekel@vumc.nl
authors.forename: N M A
authors.initials: NM
authors.lastname: Krekel
authors.forename: A M F
authors.initials: AM
authors.lastname: Lopes Cardozo
authors.forename: S
authors.initials: S
authors.lastname: Muller
authors.forename: E
authors.initials: E
authors.lastname: Bergers
authors.forename: S
authors.initials: S
authors.lastname: Meijer
authors.forename: M P
authors.initials: MP
authors.lastname: van den Tol
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018196:Carcinoma, Adenosquamous / Q000000981:diagnostic imaging / Q000601:surgery; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000601:surgery; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000601:surgery; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D059032:Learning Curve; D008297:Male; D015412:Mastectomy, Segmental / Q000193:education* / Q000379:methods*; D008875:Middle Aged; D012107:Research Design; D016217:Ultrasonography, Mammary