title: Intraoperative ultrasound in conservative surgery for non-palpable breast cancer after neoadjuvant chemotherapy.
abstract: OBJECTIVE
  A complete clinical response after neoadjuvant chemotherapy (NACT) in breast cancer patients hinders the localization of the residual lesion and the removal of a minimum amount of breast tissue. The aim of the present work is to report our single-centre experience with intraoperative ultrasound-guided (IOUS) excision performed by surgeons in these patients.
  
  
  METHODS
  From January 2008 to December 2012, IOUS excisions were performed on 58 patients with a previous intralesional ultrasound-detectable metallic marker and non-palpable breast cancer after NACT. The specimen margins were estimated by ultrasonography and macroscopic pathologic examination. Successful lesion removal, specimen weight, and analysis of the results as regards margins were evaluated, and the need for breast-conserving re-excision and mastectomy was considered.
  
  
  RESULTS
  After NACT the average ultrasound/mammography and MRI diameters were 11.7 mm (0-30) and 9.1 mm (0-40) respectively. In all cases, the residual lesion or tissue around the marker was removed. The average weight of the specimens was 26.4 g (6-84), being lower in cases of complete response according to ultrasound (p < 0.05). In 4 patients (6.8%), breast-conserving re-excision was carried out, and in 3 patients (5.2%) a secondary mastectomy was performed, two of which had invasive lobular carcinoma.
  
  
  CONCLUSIONS
  The emplacement of a readily echodetectable metal marker before NACT makes IOUS excision feasible in an increasing number of complete clinical responses, with the excision of small amounts of breast tissue and a high percentage of conservative breast surgery. This technique requires surgeons to be trained, but has the advantage of a reduced use of other hospital services, better planning of operating theatres, and less discomfort for patients, which means that it is attractive and indeed recommendable.
authors.affiliation: Department of Surgery, Breast Surgery Unit, Salamanca University Hospital, Paseo S. Vicente 82, 37007 Salamanca, Spain. Electronic address: mramos@usal.es.
authors.forename: M
authors.initials: M
authors.lastname: Ramos
authors.affiliation: Department of Radiology, Breast Unit, Salamanca University Hospital, Salamanca, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Díez
authors.affiliation: Department of Surgery, Breast Surgery Unit, Salamanca University Hospital, Paseo S. Vicente 82, 37007 Salamanca, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Ramos
authors.affiliation: Department of Nuclear Medicine, Breast Unit, Salamanca University Hospital, Salamanca, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Department of Pathology, Breast Unit, Salamanca University Hospital, Salamanca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sancho
authors.affiliation: Department of Surgery, Breast Surgery Unit, Salamanca University Hospital, Paseo S. Vicente 82, 37007 Salamanca, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: González-Orús
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D018084:Ultrasonography, Interventional / Q000379:methods; D016217:Ultrasonography, Mammary / Q000379:methods
keywords: Breast cancer; Complete clinical response; Intraoperative ultrasound localization; Neoadjuvant chemotherapy; Non-palpable; Re-excision rate