title: Optimization of breast cancer excision by intraoperative ultrasound and marking needle - technique description and feasibility.
abstract: BACKGROUND
  We present a surgical technique and the preliminary results of breast cancer excision after insertion of a specially constructed marking needle into the tumor, controlled by intraoperative ultrasound. Resection margins were projected in six directions by ultrasound measurements, determined in relation to the needle, and resection was done in accordance with those measurements. The main objective was to obtain resection margins similar (equal) to those projected by intraoperative ultrasound (10 mm).
  
  
  METHODS
  Detailed description of the technique is given. Thirty-two female patients undergoing breast-conserving surgery, up to 30 mm in diameter, for palpable and non-palpable invasive breast cancer, were operated on using this technique. Its feasibility was tested by analyzing the success (rate) of needle placement in the tumor, the measurements executed, and the performance of the excision.
  
  
  RESULTS
  All stages of the technique were successfully performed to completion on all 32 patients. The procedure of needle placement and ultrasound measurement of distances took 11 min on average (between 6 and 20 min). The average distance of the tumor margin from the resection margin was 12.9 mm (2 to 30 mm, 95% confidence interval [11.9, 14.06]). There was one patient with a positive resection margin (3%).
  
  
  CONCLUSIONS
  The technique of excising palpable and non-palpable breast cancer by intraoperative ultrasound and an especially constructed marking needle is feasible and comfortable to perform. Preliminary results imply that resection volume can be rationalized, with the same or better oncological safety.
authors.affiliation: Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. ivanovicnebojsadr@gmail.com.|Medical Faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia. ivanovicnebojsadr@gmail.com.
authors.forename: Nebojsa S
authors.initials: NS
authors.lastname: Ivanovic
authors.affiliation: Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. drdarkozdravkovic@gmail.com.|Medical Faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia. drdarkozdravkovic@gmail.com.
authors.forename: Darko D
authors.initials: DD
authors.lastname: Zdravkovic
authors.affiliation: Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. skuric.zlatko@bkosa.edu.rs.
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Skuric
authors.affiliation: Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. jelenakostic983@gmail.com.
authors.forename: Jelena
authors.initials: J
authors.lastname: Kostic
authors.affiliation: Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. colakovic.natasa@bkosa.edu.rs.
authors.forename: Natasa
authors.initials: N
authors.lastname: Colakovic
authors.affiliation: Department of Pathology, UMC Bezanijska kosa, Autoput bb, Belgrade, 11000, Serbia. miodragstojiljkovic.ms@gmail.com.
authors.forename: Miodrag
authors.initials: M
authors.lastname: Stojiljkovic
authors.affiliation: Department of Pathology, UMC Bezanijska kosa, Autoput bb, Belgrade, 11000, Serbia. opric.svetlana@bkosa.edu.rs.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Opric
authors.affiliation: Department of Radiology, UMC Bezanijska kosa, Autoput bb, Belgrade, 11000, Serbia. stefanovicradovic.magdalena@bkosa.edu.rs.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Stefanovic Radovic
authors.affiliation: Department of Statistics, Medical faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia. soldatovic.ivan@gmail.com.
authors.forename: Ivan
authors.initials: I
authors.lastname: Soldatovic
authors.affiliation: Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. sredic.biljana@bkosa.edu.rs.
authors.forename: Biljana
authors.initials: B
authors.lastname: Sredic
authors.affiliation: Department of Surgical Oncology, UMC Bezanijska Kosa, Autoput bb, Belgrade, 11000, Serbia. granic.miroslav@bkosa.edu.rs.|Medical Faculty of Belgrade University, Dr Subotica 8, Belgrade, 11000, Serbia. granic.miroslav@bkosa.edu.rs.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Granic
mesh_terms: 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; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D015412:Mastectomy, Segmental / Q000379:methods* / Q000592:standards*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D016217:Ultrasonography, Mammary / Q000379:methods*