Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective

Jeffery M Chakedis,Melinda M Mortenson,Benjamin M Raber,Dorota J Wisner,Gillian E Kuehner,Nicole M Datrice-Hill,Veronica C Shim,Jennifer R Mcevoy,Sharon B Chang,Lucinda A Romero,Liisa L Lyon,Vignesh A Arasu,Annie Tang,Brooke Vuong

doi:10.1245/s10434-021-10454-8

Abstract

BackgroundIntraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation.MethodsThe study identified breast cancer patients with BCS from 1 January to 31 October 2015 and from 1 January to 31 October 2019. Clinicopathologic characteristics were collected, and localization types were categorized. Clinical outcomes were analyzed, including localization use, surgeon adoption of IUS, day-of-surgery intervals, and re-excision rates. Multivariate logistic regression analysis was performed to evaluate predictors of re-excision.ResultsThe number of BCS procedures increased 23%, from 1815 procedures in 2015 to 2226 procedures in 2019. The IUS rate increased from 4% of lumpectomies (n = 79) in 2015 to 28% of lumpectomies (n = 632) in 2019 (p < 0.001). Surgeons using IUS increased from 6% (5 of 88 surgeons) in 2015 to 70% (42 of 60 surgeons) in 2019. In 2019, 76% of IUS surgeons performed at least 25% of lumpectomies with IUS. The mean time from admission to incision was shorter with IUS or seed localization than with wire localization (202 min with IUS, 201 with seed localization, 262 with wire localization in 2019; p < 0.001). The IUS re-excision rates were lower than for other localization techniques (13.6%, vs 19.6% for seed localization and 24.7% for wire localization in 2019; p = 0.006), and IUS predicted lower re-excision rates in a multivariable model (odds ratio [OR], 0.59).ConclusionsIn a high-volume integrated health system, IUS was adopted for BCS by a majority of surgeons. The use of IUS decreased the time from admission to incision compared with wire localization, and decreased re-excision rates compared with other localization techniques.

Highlights

Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique
We identified breast cancer patients who underwent breast-conserving surgery (BCS) during the pilot project period (1 January to 31 October 2015) and patients with BCS between 1 January and 31 October 2019 using the Kaiser Permanente Northern California (KPNC) Breast Cancer Tracking Service (BCTS), which maintains a prospective database of all KPNC breast cancer patients
The number of breast-conserving operations increased 23%, from 1815 procedures in 2015 to 2226 procedures in 2019, and intraoperative ultrasound (IUS) lumpectomies increased from 4% to 28% of all lumpectomies (p \0.001; Fig. 1)

Summary

Introduction

Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation. The study identified breast cancer patients with BCS from 1 January to 31 October 2015 and from 1 January to 31 October 2019. Clinical outcomes were analyzed, including localization use, surgeon adoption of IUS, day-of-surgery intervals, and re-excision rates. The number of BCS procedures increased 23%, from 1815 procedures in 2015 to 2226 procedures in 2019. The IUS rate increased from 4% of lumpectomies (n = 79) in 2015 to 28% of lumpectomies (n = 632) in 2019 (p \ 0.001).

Methods

Results

Conclusion