Photo Credit: SbytovaMN

The following is a summary of “Intraoperative Ultrasound-Guided Breast-Conserving Surgery: A Performance Analysis On The Basis Of Novel Cancer Lesion Classification And Patients’ Cosmetic Satisfaction,” published in the April 2025 issue of Surgery by Ferrucci et al. 

Intraoperative ultrasound-guided breast-conserving surgery offers the distinct advantage of real-time visualization of tumor boundaries and resection margins, enabling more precise excision compared to traditional techniques guided by palpation or preoperative wire localization. This prospective observational cohort study, conducted at the Veneto Institute of Oncology between January 2021 and October 2022, aimed to evaluate and compare the surgical, oncologic, and cosmetic outcomes associated with IOUS-BCS versus traditional methods across a broad spectrum of breast cancer lesion types. Eligible participants included patients diagnosed with ductal carcinoma in situ, stage T1–T2 invasive breast cancer, or residual disease following neoadjuvant therapy, all deemed appropriate candidates for breast-conserving surgery. 

Lesions were systematically categorized using a novel four-type classification system: type A (solid palpable), type B (solid non-palpable), type C (non-solid non-palpable), and type D (post-neoadjuvant residual lesions). A total of 206 patients were enrolled, evenly divided between the IOUS-BCS group (n=103) and the traditional surgery group (n=103). Despite comparable tumor volumes, the IOUS-BCS group demonstrated markedly improved surgical precision, evidenced by significantly smaller excised specimen volumes (P = .024), higher tumor-to-specimen volume ratios (P = .002), and wider closest margin widths (P < .001). Additionally, IOUS-BCS was associated with lower rates of positive margins (P = .002) and reoperations (P = .01), emphasizing its superior oncologic effectiveness. Subgroup analysis confirmed that these advantages persisted across all lesion types, with particularly notable benefits in the most technically challenging categories—types C and D. 

Importantly, one-year postoperative evaluations showed that patients who underwent IOUS-BCS reported significantly higher levels of cosmetic satisfaction (P < .001), and statistical modeling identified excised specimen volume as the only significant predictor of aesthetic outcomes (P = .001). These findings underscore the multi-dimensional benefits of IOUS-BCS, not only in achieving more accurate tumor excision and reducing the likelihood of repeat surgeries but also in preserving breast appearance and improving overall patient satisfaction. Collectively, the results support the adoption of IOUS-BCS as a modern standard for precision breast-conserving surgery, offering a compelling improvement over conventional palpation- or wire-guided techniques for a diverse range of breast cancer presentations.

Source: surgjournal.com/article/S0039-6060(24)01024-9/fulltext