title: Intraoperative Ultrasound-Guided Lumpectomy Versus Mammographic Wire Localization for Breast Cancer Patients After Neoadjuvant Treatment.
abstract: BACKGROUND
  Intraoperative ultrasound (IOUS)-guided lumpectomy in early breast cancer has shown advantages over other techniques. However, the use of IOUS has been less explored after neoadjuvant treatment (NAT). This study aimed to compare IOUS- and wire localization (WL)-guided surgery in breast cancer patients after NAT.
  
  
  METHODS
  The study enrolled patients treated with NAT who underwent breast-conserving surgery (BCS) between July 2008 and December 2012. For the patients with a hydrogel marker or residual tumor visible on ultrasound, an IOUS-guided surgery was performed (IOUS group). The patients with a standard marker or hydrogel marker not visible on ultrasound underwent a WL-guided surgery (WL group).
  
  
  RESULTS
  The study investigated 214 patients: 145 (67.8 %) in the IOUS group and 69 (32.2 %) in the WL group. The patient and tumor characteristics were comparable between the two groups. For the patients who had a pathologic complete response (pCR) or microscopic disease, the volume excised was lower in the IOUS group (p = 0.03). The rate of reexcision for positive or close margins was similar in the two groups (p = 0.80). After a median follow-up period of 43 months, the local recurrence rates did not differ significantly between the two groups.
  
  
  CONCLUSIONS
  Compared with WL surgery, IOUS seems to lower the volume of resection in patients with pCR or minimal microscopic disease after NAT without compromising margins and local recurrences. BCS can easily be achieved with IOUS for patients with a good response after NAT.
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain. irubio@vhio.net.
authors.forename: Isabel T
authors.initials: IT
authors.lastname: Rubio
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Esgueva-Colmenarejo
authors.affiliation: Breast Surgical Oncology Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Martin
authors.initials: M
authors.lastname: Espinosa-Bravo
authors.affiliation: Department of Radiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Salazar
authors.affiliation: Department of Radiology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Miranda
authors.affiliation: Department of Pathology, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Peg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D003357:Cosmetic Techniques / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D008327:Mammography; D015412:Mastectomy, Segmental; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D025321:Surgery, Computer-Assisted; D016217:Ultrasonography, Mammary
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human