Intraoperative ultrasound-guided breast-conserving surgery: A performance analysis on the basis of novel cancer lesion classification and patients' cosmetic satisfaction.

Summary

In a 206-patient prospective cohort, intraoperative ultrasound-guided breast-conserving surgery (IOUS-BCS) yielded smaller excised volumes, lower positive margin and reoperation rates, wider closest margins, and higher 1-year cosmetic satisfaction versus traditional palpation/wire-guided methods. Benefits were consistent across lesion types and most pronounced in challenging non-solid/non-palpable and post-neoadjuvant residual lesions.

Key Findings

• IOUS-BCS achieved significantly smaller excised volumes and higher tumor-to-specimen ratios versus traditional guidance (P=.024 and P=.002).
• Lower involved margin and reoperation rates with IOUS-BCS (P=.002 and P=.01), and wider closest margin width (P<.001).
• One-year cosmetic satisfaction was significantly higher; specimen volume was the only significant predictor of cosmetic satisfaction (P=.001).

Clinical Implications

Adoption of IOUS-BCS can reduce reoperations and tissue sacrifice while improving cosmesis; specimen volume should be minimized to enhance patient satisfaction.

Limitations

• Single-center, nonrandomized design may introduce selection bias.
• Follow-up limited to 1 year; long-term local control and cosmetic durability require further study.

Future Directions

Randomized, multicenter trials with longer follow-up to confirm oncologic equivalence/superiority and quantify long-term cosmetic durability and cost-effectiveness.