Intraoperative breast problem--focused sonography a valuable tool in the training of surgical residents

In surgical residency education, "hands-on" learning is important in the operating room. Mastering the interpretation of preoperative data is a must for intraoperative decisions. Because preoperative evaluations of breast masses by ultrasound are performed and interpreted in the Department of Radiology, our study aimed to assess and improve surgical residents' ability to perform ultrasound and to interpret their results before performing breast mass biopsies.

Between January 2000 and May 2007, 128 female patients found to have palpable breast masses were scheduled for biopsy. An on-table ultrasound was performed by a surgical resident under the supervision of an attending surgeon. The resident was unaware of the result reported by the Department of Radiology. The parameters used to evaluate on-table ultrasound were the echogenicity, diameter (transverse vs vertical), and margins (regular vs irregular) of patients' lesions. Based on these criteria, residents classified lesions as benign, malignant, or indeterminate. The results were compared with the preoperative ultrasound evaluations provided by the Department of Radiology and pathology reports.

Eliminating the 10 indeterminate lesions on ultrasound, the residents found that 87 lesions were benign and 31 lesions were malignant. The residents' assessment of the breast lumps had a sensitivity of 90.32% and a specificity of 96.55%, with a positive predictive value of 90.32% and a negative predictive value of 96.55%.

The residents' overall accuracy of 94.91% approximates that of the radiologists in differentiating between benign and malignant lesions. The study allowed us to assess the knowledge and skills of residents who responded as required by Accreditation Council for Graduate Medical Education core competencies.