Document Detail

Intraoperative ultrasound versus mammographic needle localization for ductal carcinoma in situ.
MedLine Citation:
PMID:  19267159     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Ductal carcinoma in situ (DCIS) often requires some method of localization to achieve breast-conserving therapy. The purpose of this study was to compare the efficacy of intraoperative ultrasound versus mammographic needle localization (MNL) for partial mastectomy in DCIS. MATERIALS AND METHODS: Data were collected from a Breast Cancer Surgery Database. All DCIS cases undergoing partial mastectomy (PM) were identified. Margin status, re-excision rates, and cost were determined for both groups. RESULTS: A total of 155 patients undergoing PM for DCIS were identified from the database. In the 96 patients undergoing ultrasound-guided PM (Group 1), the positive margin rate was 10.4%, and close margins (<1 mm) were observed in 22.9% after initial surgery. There were 59 patients who underwent MNL (Group 2); the positive margin rate was 11.9%, and close margins were observed in 27.1%. The difference between positive and close margins in Group 1 versus Group 2 was not statistically significant. The rate of re-excision was 20.8% for Group 1 and 30.5% for Group 2, resulting in 1.23 and 1.37 operations per patient, respectively. The average cost of an intraoperative ultrasound at our institution was $933 and $1858 for MNL (excluding cost of radiologic interpretation), a difference of $925 per case. CONCLUSION: Our study showed equivalent rates of positive margins and re-excision between intraoperative ultrasound and MNL when performing PM for nonpalpable DCIS. Considering the more invasive nature and increased cost of MNL, we consider surgeon-performed intraoperative ultrasound, when possible, the more cost-effective and practical procedure for patients with DCIS.
T A James; S Harlow; J Sheehey-Jones; M Hart; C Gaspari; M Stanley; D Krag; Takamaru Ashikaga; L E McCahill
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2009-03-07
Journal Detail:
Title:  Annals of surgical oncology     Volume:  16     ISSN:  1534-4681     ISO Abbreviation:  Ann. Surg. Oncol.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-03     Completed Date:  2009-06-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9420840     Medline TA:  Ann Surg Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1164-9     Citation Subset:  IM    
Department of Surgery, University of Vermont, Burlington, VT, USA.
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MeSH Terms
Aged, 80 and over
Breast Neoplasms / diagnosis*,  surgery
Carcinoma, Intraductal, Noninfiltrating / diagnosis*,  surgery
Intraoperative Period
Mammography / methods*
Mastectomy, Segmental
Middle Aged
Treatment Outcome
Ultrasonography, Mammary / methods*
Grant Support

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