Ultrasound-Assisted Tumor Surgery in Breast Cancer - A Prospective, Randomized, Single-Center Study (MAC 001)

Area of Science:

• Oncology
• Surgical Oncology
• Medical Imaging

Background:

• Breast-conserving surgery aims to remove tumors while preserving breast tissue.
• Achieving clear tumor margins is crucial to minimize recurrence risk.
• Wire-localization is a standard method for guiding surgery of non-palpable lesions, but can be associated with margin involvement.

Purpose of the Study:

• To compare the effectiveness of ultrasound-guided breast-conserving surgery versus traditional wire-guided surgery.
• To evaluate the impact of each surgical approach on tumor-free margin rates, resection volume, and surgical duration.
• To assess the reoperation rates associated with both surgical techniques.

Main Methods:

• A prospective, randomized, single-center controlled trial (MAC 001, NCT02222675) was conducted.
• Patients with ductal invasive breast cancer were randomized to either ultrasound-guided or wire-guided surgery.
• Primary outcomes included tumor-free resection margins, reoperation rates, and resection volume, analyzed by intention-to-treat.

Main Results:

• Ultrasound-guided surgery achieved significantly higher rates of tumor-free margins (93%) compared to wire-guided surgery (65%) (p=0.026).
• No significant differences were observed in resection volume or surgical duration between the two groups.
• No major complications were reported in either surgical arm.

Conclusions:

• Ultrasound-assisted breast surgery substantially increases the likelihood of achieving tumor-free margins, thereby reducing reoperation rates.
• Training breast surgeons in ultrasound techniques and ensuring its availability in operating rooms is recommended.
• This approach enhances the efficacy of breast-conserving therapy.