European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Optimizing breast conservative surgery for ductal carcinoma in situ: Comparative outcomes of intraoperative ultrasound and wire localization in achieving negative margins.
Сравнительное исследованиеСтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Esgueva A, Pitoni L, Regueira F, Rodríguez-Spiteri N, Olartecoechea B, Sobrido C, Pina L, Elizalde A, Cambeiro M, Gimeno-Morales M, Iscar T, Abengozar M, Rubio I T
Аннотация
BACKGROUND: Intraoperative ultrasound-guided surgery (IOUS) is an effective technique for invasive breast cancer, offering advantages over wire localization (WL), such as smaller resection volumes, lower rates of involved margins, and better patient satisfaction. However, evidence for ductal carcinoma in situ (DCIS) is limited. This study aimed to compare specimen margins and excision volume in DCIS treated with IOUS versus WL.
MATERIAL AND METHODS: From February 2018 to December 2023, women diagnosed with DCIS and eligible for breast-conserving surgery guided by IOUS or WL were prospectively recorded. For IOUS, a US-visible clip was placed at the biopsy site. During surgery, the distance between the clip and the end of mammographic microcalcifications was measured to guide excision. A specimen mammogram confirmed complete removal. Margin status, need for re-excision, and volume of excess healthy tissue-estimated through the calculated resection ratio (CRR)-were compared.
RESULTS: A total of 188 patients were included: 55 (29.25%) in the IOUS group and 133 (70.75%) in the WL group. IOUS patients were younger (p = 0.01). Tumor size (p = 0.11) and grade (p = 0.46) were similar between groups. IOUS achieved higher rates of negative margins (>2mm, p = 0.005) and fewer close margins (0.1-2mm, p = 0.03). Surgical volumes did not differ (p = 0.39). Re-excision rates were lower with IOUS (p = 0.05). Multivariate analysis showed IOUS significantly reduced re-excisions (OR 0.1; 95% CI 0.01-0.6) and close/positive margins (OR 0.1; 95% CI 0.02-0.5). Disease-free survival was similar between groups.
CONCLUSIONS: IOUS is an accurate localization method for DCIS surgery, reducing re-excisions by increasing rates of negative margins compared with WL.
MATERIAL AND METHODS: From February 2018 to December 2023, women diagnosed with DCIS and eligible for breast-conserving surgery guided by IOUS or WL were prospectively recorded. For IOUS, a US-visible clip was placed at the biopsy site. During surgery, the distance between the clip and the end of mammographic microcalcifications was measured to guide excision. A specimen mammogram confirmed complete removal. Margin status, need for re-excision, and volume of excess healthy tissue-estimated through the calculated resection ratio (CRR)-were compared.
RESULTS: A total of 188 patients were included: 55 (29.25%) in the IOUS group and 133 (70.75%) in the WL group. IOUS patients were younger (p = 0.01). Tumor size (p = 0.11) and grade (p = 0.46) were similar between groups. IOUS achieved higher rates of negative margins (>2mm, p = 0.005) and fewer close margins (0.1-2mm, p = 0.03). Surgical volumes did not differ (p = 0.39). Re-excision rates were lower with IOUS (p = 0.05). Multivariate analysis showed IOUS significantly reduced re-excisions (OR 0.1; 95% CI 0.01-0.6) and close/positive margins (OR 0.1; 95% CI 0.02-0.5). Disease-free survival was similar between groups.
CONCLUSIONS: IOUS is an accurate localization method for DCIS surgery, reducing re-excisions by increasing rates of negative margins compared with WL.