Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice.
BACKGROUND
Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice.


METHODS
Patients with nonpalpable lesions who underwent NL or HUG lumpectomy from January 2007 to December 2009 by a single surgeon were identified from a breast surgery database. Ease of scheduling, volume excised, re-excision rates, operating room time, and health care charges were the main outcomes variables. Univariate and multivariate analyses were performed to compare the 2 groups.


RESULTS
Lumpectomy was performed in 110 patients, 55 underwent HUG and 55 underwent NL. Hematoma ultrasound-guided lumpectomy was associated with a nearly 3-fold increase in the odds ratio of additional tissue being submitted to pathology (p = 0.039), but neither the total amount of breast tissue removed, nor the need for second procedure were statistically different between the 2 groups. Duration of the surgical procedure did not vary between the 2 groups; however, the time from biopsy to surgery was shorter for HUG by an expected 9.7 days (p = 0.019), implying greater ease of scheduling. Mean charges averaged $250 less for HUG than for NL, but this difference was not statistically significant.


CONCLUSIONS
Hematoma ultrasound-guided is equivalent to NL with regard to volume of tissue excised, need for operative re-excision, and operating room time. Adoption of HUG in our practice allowed for more timely surgical care.
Department of Surgery, University of Iowa, Iowa City, IA 52242, USA.
Gregory
G
Larrieux
Julie A
JA
Cupp
Junlin
J
Liao
Carol E H
CE
Scott-Conner
Ronald J
RJ
Weigel
D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001940:Breast / Q000473:pathology / Q000601:surgery; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007484:Iowa; D015412:Mastectomy, Segmental / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009339:Needles; D011300:Preoperative Care / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000191:economics / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000191:economics / Q000379:methods*