Abstract
PurposeMargin status is one of the most important predictors of local recurrence after breast conserving surgery (BCS). Intraoperative ultrasound guidance (IOUS) has the potential to improve surgical accuracy for breast cancer. The purpose of the present meta-analysis was to determine the efficacy of IOUS in breast cancer surgery and to compare the margin status to that of the more traditional Guide wire localization (GWL) or palpation-guidance.MethodsWe searched the database of PubMed for prospective and retrospective studies about the impact of IOUS on margin status of breast cancer, and a meta-analysis was conducted.ResultsOf the 13 studies included, 8 were eligible for the impact of IOUS on margin status of non-palpable breast cancers, 4 were eligible for palpable breast cancers, and 1 was for both non-palpable and palpable breast cancers. The rate of negative margins of breast cancers in IOUS group was significantly higher than that in control group without IOUS (risk ratio (RR) = 1.37, 95% confidence interval (CI) = 1.18–1.59 from 7 prospective studies, odds ratio (OR) = 2.75, 95% CI = 1.66–4.55 from 4 retrospective studies). For non-palpable breast cancers, IOUS-guidance enabled a significantly higher rate of negative margins than that of GWL-guidance (RR = 1.26, 95% CI = 1.09–1.46 from 6 prospective studies; OR = 1.45, 95% CI = 0.86–2.43 from 2 retrospective studies). For palpable breast cancers, relative to control group without IOUS, the RR for IOUS associated negative margins was 2.36 (95% CI = 1.26–4.43) from 2 prospective studies, the OR was 2.71 (95% CI = 1.25–5.87) from 2 retrospective studies.ConclusionThis study strongly suggests that IOUS is an accurate method for localization of non-palpable and palpable breast cancers. It is an efficient method of obtaining high proportion of negative margins and optimum resection volumes in patients undergoing BCS.
Highlights
Breast cancer is the most common malignancy among women in the world [1]
All the eligible studies focused on the investigation of a possible improvement of margin status when Intraoperative ultrasound guidance (IOUS) was used during surgery, compared with surgery without IOUS
For all prospective studies included, the rate of negative margins of breast cancers in IOUS group (536/613) was significantly higher than that in control group without IOUS (300/403) (RR = 1.63, 95% confidence interval (CI) = 1.10-2.42, P = 0.010 for heterogeneity) (Table 2)
Summary
As the improvements in imaging techniques, the increased awareness of patients and widespread screening mammography, the number of women diagnosed with early stage breast cancer has increased during the past decades [2]. It is well known that obtaining negative surgical margins during BCS procedures is considered to be critically important in decreasing recurrence rates [5,6]. The current focus is on improving the surgical accuracy of BCS, especially a higher rate of margin negative with smaller excision volume [7,8]. Guide wire localization (GWL) is a standard technique for localization of non-palpable breast lesions [9]. Tumor excision is usually guided by preoperative diagnostic images and experience and tactile skills of the surgeons. Palpation-guided surgery could lead high incidence of positive margins, ranging from 20% to 60% [12,13]
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