title: [Breast-conserving surgery for breast cancer: still much to be gained].
abstract: OBJECTIVE
  To conduct qualitative research into breast-conserving surgery for palpable and non-palpable breast tumours and the various methods of excising these, measured by the volume exised and surgical radicality.
  
  
  METHODS
  Retrospective, multicentre study.
  
  
  METHODS
  The pathology reports from 726 patients who had undergone breast-conserving surgery for invasive breast cancer were reviewed for excision volume and radicality. Any excess resected breast tissue was expressed by a Calculated Resection Ratio (CRR) and calculated by dividing the volume of the surgical specimen by the tumour volume plus an ideal 1-cm-margin of tumour-free breast tissue. A CRR of 1.0 meant that the volume excised was ideal; a CRR of 2.0 meant that twice the necessary amount of tissue had been removed.
  
  
  RESULTS
  Of all the 726 tumours, 72% appeared to be palpable. The median CRR in this group was 2.2 (range: 0.1 - 43.0) and the percentage of tumour-involved margins (irradicality) was 22.5%. Of all the non-palpable tumour (n = 201) excisions, 58% had been guided by wire-localisation, 26% by ultrasonography, and 16% by ROLL (Radio-guided Occult Lesion Localization). The CRRs were 2.8, 3.2 and 3.8, respectively (p < 0.05). Ultrasound-guided surgery resulted in the lowest rate of tumour-involved margins (ultrasound-guided: 3.8%, wire-guided localisation: 21.4%, ROLL: 25.0% (p = 0.05)).
  
  
  CONCLUSIONS
  Breast-conserving surgery is associated with an average of a 2 to 4-fold removal of excessive tissue. Nevertheless, 1 out of 5 excisions are not radical. Ultrasound-guided surgery for non-palpable breast cancer is the most effective method for achieving radical excision. A multicentre, prospective, randomised trial has been started to assess whether ultrasound-guided lumpectomy for palpable breast cancer can lead to optimisation of the excision volume and radicality.
authors: VU medisch centrum, Afd. Chirurgische Oncologie, Amsterdam, the Netherlands.
authors: Nicole M A
authors: NM
authors: Krekel
authors: Max H
authors: MH
authors: Haloua
authors: Sandra
authors: S
authors: Muller
authors: Elisabeth
authors: E
authors: Bergers
authors: Derek H F
authors: DH
authors: Rietveld
authors: Sybren
authors: S
authors: Meijers
authors: M Petrousjka
authors: MP
authors: van den Tol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D010173:Palpation; D012189:Retrospective Studies; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary