Use of an intraoperative ultrasonography-guided localization and tissue fixation device demonstrates less margin positivity during breast-conserving surgery for invasive breast cancer than standard preoperative needle-wire localization: a retrospective comparative analysis in a consecutively treated case series

Abstract

Purpose: To retrospectively compare 2 methods of pre-resection, image-guided tumor localization-preoperative needle-wire localization (PNWL) and intraoperative ultrasonography-guided localization and tissue fixation (IUGLTF)-for patients with invasive breast cancer at the time of breast-conserving surgery (BCS).

Patients and methods: We identified 118 cases in which image-guided localization was required for nonpalpable and questionably palpable tumors from a series of 204 consecutive invasive breast cancers treated by BCS. We defined a positive margin as tumor at the inked surface. We defined a close margin as tumor within 1 mm or less of the inked surface.

Results: Of those 118 cases requiring pre-resection, image-guided localization, 54 patients underwent PNWL and 64 underwent IUGLTF placement. A positive margin was identified in 6 of 54 (11.1%) undergoing PNWL compared with 1 of 64 (1.6%) undergoing IUGLTF (P = .046). A positive or close margin was identified in 9 of 54 (16.7%) undergoing PNWL compared with 3 of 64 (4.7%) undergoing IUGLTF (P = .032). The mean volume and mean weight of the BCS specimens were not different in the 2 groups.

Conclusion: Based on the finding of less margin positivity associated with the IUGLTF technique than the PNWL technique, we believe that the use of an IUGLTF device by surgeons during BCS could be highly advantageous in the surgical management of nonpalpable and questionably palpable invasive breast cancers.

Keywords: Breast cancer; Breast-conserving surgery; Image-guided; Intraoperative; Localization.