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Updated: Apr 25, 2026
Ultrasonographic Evaluation of Breast Cancer-related Lymphedema
Published on: January 12, 2017
Redefining Margin Assessment in Breast Conservation Surgery: Surgeon-Performed Intraoperative Ultrasound as a
Tabrej Alam1, Arvind Baghel1, Devashish Mishra2
1Department of Surgery, NSCB Medical College, Jabalpur, India.
Objective:
Accurate intraoperative margin assessment during breast-conserving surgery (BCS) is essential to minimize re-excision and preserve cosmesis. In resource-constrained settings, advanced imaging and frozen section analysis are often unavailable, and surgeons frequently rely on visual-tactile judgment. This study compared the diagnostic accuracy of surgeon-performed intraoperative specimen ultrasound (IOSpUS-S), radiologist-performed specimen ultrasound (IOSpUS-R), specimen mammography, and gross inspection against final histopathology.
Materials And Methods:
This prospective study included 40 patients with early breast cancer undergoing wide local excision at a tertiary centre in central India. Each excised specimen was evaluated intraoperatively, ex vivo, by gross inspection, IOSpUS (surgeon and radiologist), and specimen mammography. Diagnostic parameters, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and correlation with the final histopathological margins, were calculated. Receiver operating characteristic analysis was performed to determine discriminative performance.
Results:
Both surgeon- and radiologist-performed IOSpUS achieved identical diagnostic performance: sensitivity 100%, specificity 100.0%, PPV 100.0%, NPV 97.5%, and accuracy 97.6%. Specimen mammography showed similar results, whereas gross inspection had zero sensitivity but 100% specificity, with an overall accuracy of 95.0%. The mean histopathological margin width was 13.2±3.7 mm. IOSpUS showed a strong correlation with histopathology (r = 0.87 for surgeon-performed and r = 0.83 for radiologist-performed; p<0.001). Only one patient (2.5%) had a close margin that was correctly identified by both IOSpUS modalities and mammography, but was missed on gross inspection.
Conclusion:
Surgeon-performed IOSpUS provides real-time, workflow-efficient intraoperative margin assessment, with diagnostic performance comparable to that of radiologist-performed ultrasound and specimen mammography in this prospective cohort. In low-resource environments, gross examination, though less sensitive, remains a viable adjunct when imaging facilities are limited. A combined approach has the potential to reduce re-excision by supporting intraoperative decision-making.
