title: Ultrasonography-guided breast-conserving surgery is superior to palpation-guided surgery for palpable breast cancer.
abstract: BACKGROUND
  The aim of this study was to determine the efficacy of ultrasonography (US)-guided excision of palpable breast cancer and to compare it with the standard palpation-guided breast-conserving surgery (BCS).
  
  
  METHODS
  For this purpose, 335 women with palpable breast cancer who underwent BCS were retrospectively studied. The positive surgical margins and re-excision rates were investigated.
  
  
  RESULTS
  Of the total cohort, 137 patients were treated with palpation-guided BCS and 198 underwent US-guided tumor excision. The tumor and patient characteristics were similar in both groups. Patient age, postmenopausal status, tumor size, histological grade, intraductal tumor component, lobular histology, and palpation-guided tumor excision were associated with increased risk of positive margins. The shave margins were re-excised at the time of original operation more often by palpation-guided localization (28.5%) than by the US-guided procedure (11.1%) (P < .0001). A surgeon was able to correctly identify the "problematic" margin in 81.1% of cases via intraoperative US and in only 17.9% via palpation (P < .0001). The re-excision rate during a second operation was significantly reduced by US-guided tumorectomy (P = .004). Of 198 patients in the US-guided group, 23 (11.6%) underwent a second operation, as did 33 of 137 patients in the palpation group (24.1%). The sensitivity and specificity of US-guided excisions were 52.7% and 97.5%, respectively, whereas the sensitivity and the specificity of palpation-guided tumor excisions were 15.5% and 65.9%, respectively.
  
  
  CONCLUSIONS
  US-guided BCS is superior to palpation-guided excision in predicting the closest margins, obtaining clear surgical margins, and reducing re-operations.
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Holm
authors.initials: H
authors.lastname: Eggemann
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Ignatov
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Beni
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany.
authors.forename: Serban Dan
authors.initials: SD
authors.lastname: Costa
authors.affiliation: Department of Obstetrics and Gynecology, University Clinic Magdeburg, Magdeburg, Germany; Department of Obstetrics and Gynecology, University Medical Center Regensburg, Regensburg, Germany. Electronic address: atanas.ignatov@gmail.com.
authors.forename: Atanas
authors.initials: A
authors.lastname: Ignatov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D010173:Palpation; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Breast cancer; Breast-conserving surgery; Tumorectomy; Ultrasonography; Ultrasound