Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice

Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice.

Patients with nonpalpable lesions who underwent NL or HUG lumpectomy from January 2007 to December 2009 by a single surgeon were identified from a breast surgery database. Ease of scheduling, volume excised, re-excision rates, operating room time, and health care charges were the main outcomes variables. Univariate and multivariate analyses were performed to compare the 2 groups.

Lumpectomy was performed in 110 patients, 55 underwent HUG and 55 underwent NL. Hematoma ultrasound-guided lumpectomy was associated with a nearly 3-fold increase in the odds ratio of additional tissue being submitted to pathology (p = 0.039), but neither the total amount of breast tissue removed, nor the need for second procedure were statistically different between the 2 groups. Duration of the surgical procedure did not vary between the 2 groups; however, the time from biopsy to surgery was shorter for HUG by an expected 9.7 days (p = 0.019), implying greater ease of scheduling. Mean charges averaged $250 less for HUG than for NL, but this difference was not statistically significant.

Hematoma ultrasound-guided is equivalent to NL with regard to volume of tissue excised, need for operative re-excision, and operating room time. Adoption of HUG in our practice allowed for more timely surgical care.