title: Use of an intraoperative ultrasonography-guided localization and tissue fixation device demonstrates less margin positivity during breast-conserving surgery for invasive breast cancer than standard preoperative needle-wire localization: a retrospective comparative analysis in a consecutively treated case series.
abstract: OBJECTIVE
  To retrospectively compare 2 methods of pre-resection, image-guided tumor localization-preoperative needle-wire localization (PNWL) and intraoperative ultrasonography-guided localization and tissue fixation (IUGLTF)-for patients with invasive breast cancer at the time of breast-conserving surgery (BCS).
  
  
  METHODS
  We identified 118 cases in which image-guided localization was required for nonpalpable and questionably palpable tumors from a series of 204 consecutive invasive breast cancers treated by BCS. We defined a positive margin as tumor at the inked surface. We defined a close margin as tumor within 1 mm or less of the inked surface.
  
  
  RESULTS
  Of those 118 cases requiring pre-resection, image-guided localization, 54 patients underwent PNWL and 64 underwent IUGLTF placement. A positive margin was identified in 6 of 54 (11.1%) undergoing PNWL compared with 1 of 64 (1.6%) undergoing IUGLTF (P = .046). A positive or close margin was identified in 9 of 54 (16.7%) undergoing PNWL compared with 3 of 64 (4.7%) undergoing IUGLTF (P = .032). The mean volume and mean weight of the BCS specimens were not different in the 2 groups.
  
  
  CONCLUSIONS
  Based on the finding of less margin positivity associated with the IUGLTF technique than the PNWL technique, we believe that the use of an IUGLTF device by surgeons during BCS could be highly advantageous in the surgical management of nonpalpable and questionably palpable invasive breast cancers.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH. Electronic address: stephen.povoski@osumc.edu.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Povoski
authors.affiliation: Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Rafael E
authors.initials: RE
authors.lastname: Jimenez
authors.affiliation: Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH.
authors.forename: Wenle P
authors.initials: WP
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016707:Tissue Fixation / Q000295:instrumentation*; D018084:Ultrasonography, Interventional; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Breast cancer; Breast-conserving surgery; Image-guided; Intraoperative; Localization