Abstract P4-10-12: Wire Guided Breast Procedures with Intraoperative Ultrasound

Abstract

Abstract Background: Wire guided breast procedures (WGBP) are the most commonly used breast conserving operation for non-palpable cancers. Suboptimal needle placement can result in a larger amount of tissue removed and increased difficulty in removal of the lesion. The use of intraoperative ultrasound can improve the execution of wire guided breast procedures by more precisely demonstrating the direction and depth of the wire as well as the location of the wire hook and radiographic clip. These benefits allow a more appropriately located incision and smaller volume of tissue removed. Methods: A retrospective review of all patients who underwent the WGBP at a county hospital with associated surgical residency program. 28 patients underwent the procedure with intraoperative ultrasound from June 2009 to March 2010. Results: Breast cancer patients who underwent a wire-guided lumpectomy with intraoperative ultrasound had a lower rate of positive margins (9% vs. 26%, p = 0.28) and a smaller volume of tissue removed (126 cm3 vs. 146 cm3, p = 0.57) compared to patients who underwent wire guided lumpectomy alone. In patients who underwent wire guided excisional biopsy for diagnostic purposes, the volume of tissue removed was smaller in the intraoperative ultrasound group (30 cm3 vs. 44 cm3, p = 0.17) and the targeted area was more likely to be removed in one specimen (1.1 vs. 1.5, p = 0.03) compared to those who underwent the procedure without intraoperative ultrasound. Two illustrative cases with figures are presented. The first demonstrates the benefit when the distance from skin entry point of the wire to the target area is great. The hook can be localized with ultrasound for optimal placement of the incision. The second demonstrates potential benefit when wire placement is suboptimal and the wire hook is distant from the target. The surgeon may use the wire location to identify the approximate area of the lesion and then the exact location of the radiographic clip can be localized with intraoperative ultrasound. Conclusions: Intraoperative ultrasound can improve surgical outcomes of the wire guided breast procedure. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-12.