title: Localization of nonpalpable breast lesions with sonographically visible clip: optimizing tailored resection and clear margins.
abstract: BACKGROUND
  Achieving clear margins with adequate resection volumes is one of the principal goals of breast-conserving surgery. The aim of our study was to compare preoperative localization using 2 different clips, radiopaque or sonographically visible, to reach this goal.
  
  
  METHODS
  We reviewed 209 consecutive nonpalpable breast cancers that were treated with lumpectomy: 59 with radiopaque and 150 with sonographically visible clip positioned during biopsy procedure. In the former case, preoperative localization was performed with mammography and in the latter by ultrasonography.
  
  
  RESULTS
  Clear margins were achieved in 80.4% of patients: 57.6% in the first and 89.3% in the second group (P < .0001; odds ratio, 7.6; 95% confidence interval, 3.4 to 17.2). By using sonographically visible clips, the re-excision rate has decreased from 42.4% to 10.7%, (P < .0001), and resections resulted smaller with average calculated resection ratio of 3.54 vs. 5.08 (P = .03).
  
  
  CONCLUSIONS
  Preoperative localization using a sonographically visible clip allows a more tailored breast-conserving surgery and reduces the re-excision rate.
authors.affiliation: Surgery Division, Luigi Sacco Hospital, Via G. B. Grassi 74, Milan 20157, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan 20157, Italy. Electronic address: fabio.corsi@unimi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Corsi
authors.affiliation: Surgery Division, Luigi Sacco Hospital, Via G. B. Grassi 74, Milan 20157, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Sorrentino
authors.affiliation: Surgery Division, Luigi Sacco Hospital, Via G. B. Grassi 74, Milan 20157, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sartani
authors.affiliation: Surgery Division, Luigi Sacco Hospital, Via G. B. Grassi 74, Milan 20157, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bossi
authors.affiliation: Radiology Division, Luigi Sacco Hospital, Via G. B. Grassi 74, Milan 20157, Italy.
authors.forename: Rosella
authors.initials: R
authors.lastname: Amadori
authors.affiliation: Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan 20157, Italy; Pathology Division, Luigi Sacco Hospital, Via G. B. Grassi 74, Milan 20157, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Nebuloni
authors.affiliation: Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan 20157, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Truffi
authors.affiliation: Centro Studi Epidemiologia e Medicina Preventiva, Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bonzini
authors.affiliation: Surgery Division, Luigi Sacco Hospital, Via G. B. Grassi 74, Milan 20157, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan 20157, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Foschi
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D015412:Mastectomy, Segmental; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000295:instrumentation / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D016217:Ultrasonography, Mammary
keywords: Breast-conserving surgery; Clip; Margin status; Nonpalpable breast cancer; Resection volume; Ultrasonography