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Impact of Standardized Intraoperative Ultrasound on Re-excision Rates in Breast-Conserving Surgery
Bettina Boeer1, Felix Seltenreich1, Birgitt Schönfisch1
1University Hospital Tübingen, Department of Women's Health, BW, Germany, Tübingen.
Ultraschall in Der Medizin (Stuttgart, Germany : 1980)
|August 13, 2026
Summary
Standardizing intraoperative ultrasound (IOUS) with the Tübingen Ultrasound Ruler significantly reduced positive margin rates in breast-conserving surgery. This technique achieved an 8.5% re-excision rate, lower than national averages.
Area of Science:
- Oncology
- Surgical Oncology
- Medical Imaging
Background:
- Breast-conserving surgery (BCS) aims for complete tumor removal with negative margins (R0).
- Intraoperative ultrasound (IOUS) can decrease re-excision rates (R1) for visible tumors.
- A standardized IOUS technique is needed to optimize outcomes.
Purpose of the Study:
- To evaluate if standardizing IOUS with the "Tübingen Ultrasound Ruler" reduces R1 resection rates in BCS.
- To assess the efficacy of a standardized IOUS technique in achieving negative margins.
Main Methods:
- Retrospective analysis of 273 patients undergoing BCS by a single surgeon.
- Standardized IOUS technique using the "Tübingen Ultrasound Ruler" with >10 mm sonographic margins.
- Specimen imaging and targeted margin shavings when indicated.
Main Results:
- The initial R1 rate was 18.8% for main specimens.
- Targeted IOUS-guided shavings reduced the R1 rate to 8.5%.
- This rate (8.5%) was significantly lower than the reported average of 12.34% in certified breast centers (p=0.043).
Conclusions:
- Standardized IOUS technique combined with imaging-guided shavings achieves low R1 rates in BCS.
- The "Tübingen Ultrasound Ruler" aids in optimizing margin assessment during surgery.
- This approach improves oncologic outcomes in breast cancer surgery.
