Surgeon‐performed intraoperative ultrasonography‐guided excision of nonpalpable breast masses with adequate surgical margins under local anaesthesia

Abstract

AimWith the improvement of expertise in technique and skills of ultrasonography (US), many surgeons now perform image‐guided procedures for breast masses themselves. To minimize operative time, and to achieve adequate surgical margins with an acceptable cosmetic outcome, we designed a safe and simple hybrid technique to excise suspicious nonpalpable masses, which is described herein for the first time.Patients and MethodsIntraoperatively‐marked incision is performed, and a needle is advanced at a 0.5‐cm distance to the lesion according to real‐time ultrasound measurements. Four deep sutures are passed to fix and hang the predicted specimen adjacent to the needle in four directions. En bloc excision with aimed surgical margins of approximately 0.5 cm is achieved by means of retracting sutures, and confirmed by specimen and tumour bed US.ResultsIn the present study, there were 25 women (17 with malignant and 8 with benign lesions), with a mean age of 50.88 years (range: 30–69) and mean tumour diameter of 10.6 mm (range: 6–15). All lesions were correctly identified and localized by intraoperative US, and free margins of excision were obtained in all malignant lesions by means of the presented technique. The combined operative technical approach with surgeon‐performed intraoperative US‐guided needle placement and retracting sutures were feasible, simple and beneficial. We achieved complete tumour removal in all dimensions with no reexcision. The procedure was performed under local anaesthesia in an outpatient fashion with no complications.ConclusionOur report of the operative technique demonstrates that a combination of surgeon‐performed image‐guided localizations, together with a suture‐oriented fashion to assure negative surgical margins in all dimensions, improves margin clearance rate at the time of first surgical intervention. This method can be performed with operative and cost efficiency, and might become a valuable tool to minimize operative time and yield minimal sacrifice of normal breast tissue with maximal cosmetic outcome.