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

Abstract

Intraoperative ultrasound-guided breast-conserving surgery guarantees real-time direct visualization of tumor and resection margins. We compared surgical, oncologic, and cosmetic outcomes between intraoperative ultrasound-guided breast-conserving surgery and traditional (palpation- or wire-guided) surgery across all breast cancer lesion types. This prospective observational cohort study was conducted at the Veneto Institute of Oncology between January 2021 and October 2022. Patients with ductal carcinoma in situ, T1-2 invasive breast cancer, or post-neoadjuvant residual lesions, who were suitable for breast-conserving surgery were enrolled. A novel classification system categorized all breast cancer lesion types: solid palpable (type A); solid non-palpable (B); non-solid non-palpable (C); and post-neoadjuvant residual lesions (D). Main outcomes included involved margin rates, excision volumes, and cosmetic satisfaction. In total, 206 patients were enrolled, with 103 receiving traditional (palpation- or wire-guided) surgery and 103 undergoing intraoperative ultrasound-guided breast-conserving surgery. Despite similar tumor volumes, intraoperative ultrasound-guided breast-conserving surgery resulted in significantly smaller excised volumes (P = .024), greater tumor volume to specimen volume ratios (P = .002), and lower involved margin and reoperation rates (P = .002 and P = .01, respectively), in addition to a wider closest margin width (P < .001). Stratified analyses demonstrated superior performance of intraoperative ultrasound-guided breast-conserving surgery across all breast cancer lesion types, with notable improvements observed in the most challenging ones (types C and D). One-year follow-up assessments revealed significantly greater patient satisfaction levels after intraoperative ultrasound-guided breast-conserving surgery (P < .001), with specimen volume identified as the sole significant predictor of cosmetic satisfaction (P = .001). Intraoperative ultrasound-guided breast-conserving surgery showed clear superiority over traditional (palpation- or wire-guided) surgery in oncologic, surgical, and cosmetic outcomes, as demonstrated by a comprehensive stratified analysis encompassing all breast cancer lesion types. Intraoperative ultrasound-guided breast-conserving surgery represents the latest and most effective paradigm for precision breast-conserving surgery.