A decade of intraoperative ultrasound guided breast conservation for margin negative resection – Radioactive, and magnetic, and Infrared Oh My…
| Autor: | Rakhshanda Layeequr Rahman, Sybil L. Crawford, Zaina Habrawi, Yana Puckett |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Reoperation
medicine.medical_specialty medicine.medical_treatment Breast Neoplasms Mastectomy Segmental 030218 nuclear medicine & medical imaging Intraoperative Period 03 medical and health sciences 0302 clinical medicine Breast cancer Margin (machine learning) medicine Humans Prospective Studies Stage (cooking) Mastectomy Aged Neoplasm Staging business.industry Ultrasound Margins of Excision General Medicine Odds ratio Middle Aged Ductal carcinoma medicine.disease 030220 oncology & carcinogenesis Invasive lobular carcinoma Female Surgery Ultrasonography Mammary Radiology business |
| Zdroj: | The American Journal of Surgery. 220:1410-1416 |
| ISSN: | 0002-9610 |
| DOI: | 10.1016/j.amjsurg.2020.09.008 |
| Popis: | Background The oncologic goal of margin-negative breast conservation requires adequate localization of tumor. Intraoperative ultrasound remains most feasible but under-utilized method to localize the tumor and assess margins. Methods A prospectively maintained breast cancer database over a decade was queried for margin status in breast cancer patients undergoing breast conservation. Techniques of tumor localization, margin re-excision and closest margins were analyzed. Rate of conversion to mastectomy was determined. Results Of the 945 breast cancer patients treated at a university-based Breast Center of Excellence between January 1, 2009 and December 31, 2018, 149(15.8%) had ductal carcinoma in situ; 712(75.3%) had invasive ductal carcinoma, and 63(6.7%) had invasive lobular carcinoma. Clinical stage distribution was: T1 = 372(39.4%); T2 = 257(27.2%); T3 = 87(9.2%). Five hundred and eighty three (61.7%) patients underwent breast conservation. The median (25th −75th centile) closest margin was 6(2.5, 10.0) mm. Thirty five (6.0%) patients underwent margin re-excision, of which 9(25%) were converted to mastectomy. Tumor localization was achieved with ultrasound in 521(89.4%) patients and with wire localization in 62(10.6%) patients. The median (25th-75th centile) closest margin with wire localization was 5.0(2.0, 8.5) mm versus 5.0 (2.0, 8.0) mm with ultrasound guidance [p = 0.6635]. The re-excision rate with wire localization was 14.5% versus 4.9% with ultrasound guidance [p = 0.0073]. The unadjusted Odds Ratio (95% CI) for margin revision in wire localized group compared with ultrasound was 3.2 (7.14, 1.42) [p = 0.0045]; multivariate adjusted OR (95%) was 4(9.09, 1.7) [p = 0.0013]. Conclusions Ultrasound guidance for localization of breast cancer remains the most effective option for margin negative breast conservation. |
| Databáze: | OpenAIRE |
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