May the Completion Lead to Conservation: Impact of Partial and Complete Intraoperative Ultrasound Application on...

This study aimed to enhance resection margin management during breast-conserving surgery by applying intraoperative ultrasound (IOUS) together with palpation or wire guidance.

This single-center retrospective observational cohort study was conducted between January 2022 and December 2024. Data were collected from patients with a diagnosis of invasive breast cancer who were treated with lumpectomy. Surgical treatment varied based on the extent of IOUS application. Outcomes included occurrences of positive resection margins (PRM), close resection margins with widths smaller than 1 mm (PCRM<1 mm), and close resection margins with widths smaller than 2 mm (PCRM<2mm). To investigate the extent of breast tissue removal, closest margin widths (CMWs) were compared.

In this study, IOUS was completely used in 72 cases and partially applied in 58 cases, whereas 176 patients underwent standard therapy without IOUS. The PRM rates were 1.4 % for complete IOUS, 5.2 % for partial IOUS, and 13.1 % for standard therapy. The corresponding PCRM<1mm rates were 5.6 %, 17.2 %, and 23.3 %, whereas the corresponding PCRM<2mm rates were 15.3 %, 27.6 %, and 28.4 %. The extent of IOUS application was significantly associated with a reduction in PRM (p = 0.007) and PCRM<1mm (p = 0.004). Multivariate analysis identified complete IOUS as an independent protective factor against PRM (adjusted odds ratio [aOR], 0.06; 95 % confidence interval [CI], 0.01-0.50; p = 0.009), PCRM<1mm (aOR, 0.13; 95 % CI, 0.04-0.41; p < 0.001), and PCRM<2mm (aOR, 0.32; 95 % CI, 0.14-0.74; p = 0.008) compared with standard therapy. The CMW was similar across study groups (p = 0.331).

In breast-conserving surgery for invasive breast cancer, IOUS enhanced resection margin management. The complete application of IOUS may be essential for reducing the rate of close resection margins during IOUS-guided lumpectomy.