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Intraoperative Ultrasound-Guided Lumpectomy Versus Mammographic Wire Localization for Breast Cancer Patients After Neoadjuvant Treatment

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Intraoperative ultrasound (IOUS)-guided lumpectomy in early breast cancer has shown advantages over other techniques. However, the use of IOUS has been less explored after neoadjuvant treatment (NAT). This study aimed to compare IOUS- and wire localization (WL)-guided surgery in breast cancer patients after NAT.

Methods

The study enrolled patients treated with NAT who underwent breast-conserving surgery (BCS) between July 2008 and December 2012. For the patients with a hydrogel marker or residual tumor visible on ultrasound, an IOUS-guided surgery was performed (IOUS group). The patients with a standard marker or hydrogel marker not visible on ultrasound underwent a WL-guided surgery (WL group).

Results

The study investigated 214 patients: 145 (67.8 %) in the IOUS group and 69 (32.2 %) in the WL group. The patient and tumor characteristics were comparable between the two groups. For the patients who had a pathologic complete response (pCR) or microscopic disease, the volume excised was lower in the IOUS group (p = 0.03). The rate of reexcision for positive or close margins was similar in the two groups (p = 0.80). After a median follow-up period of 43 months, the local recurrence rates did not differ significantly between the two groups.

Conclusions

Compared with WL surgery, IOUS seems to lower the volume of resection in patients with pCR or minimal microscopic disease after NAT without compromising margins and local recurrences. BCS can easily be achieved with IOUS for patients with a good response after NAT.

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References

  1. Kaufmann M, von Minckwitz G, Bear H, et al. Recommendations from an international expert panel on the use of neoadjuvant (primary) systemic treatment of operable breast cancer: new perspectives 2006. Ann Oncol. 2007;18:1927–34.

    Article  PubMed  CAS  Google Scholar 

  2. Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998;16:2672–85.

    PubMed  CAS  Google Scholar 

  3. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and B-27. J Clin Oncol. 2008;26:778–85.

    Article  PubMed  Google Scholar 

  4. van der Hage JA, van de Velde CJ, Julien JP, et al. Preoperative chemotherapy in primary operable breast cancer: results from the European organization for research and treatment of cancer trial 10902. J Clin Oncol. 2001;19:4224–37.

    PubMed  Google Scholar 

  5. Chen A, Meric-Bernstam F, Hunt K, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol. 2004;22:2303–12.

    Article  PubMed  Google Scholar 

  6. Kuerer HM, Hunt KK, Newman LA, Ross MI, Ames FC, Singletary SE. Neoadjuvant chemotherapy in women with invasive breast carcinoma: conceptual basis and fundamental surgical issues. J Am Coll Surg. 2000;190:350–63.

    Article  PubMed  CAS  Google Scholar 

  7. Bear HD. The effect on tumor response of adding sequential preoperative docetaxel to preoperative doxorubicin and cyclophosphamide: preliminary results from National Surgical Adjuvant Breast and Bowel Project Protocol B27. J Clin Oncol. 2003;21:4165–74.

    Article  PubMed  CAS  Google Scholar 

  8. Minckwitz von G, Untch M, Blohmer J-U, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012;30:1796–804.

    Article  Google Scholar 

  9. Baselga J, Bradbury I, Eidtmann H, NeoALTTO Study Team, et al. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomized, open-label, multicentre, phase 3 trial. Lancet. 2012;379:633–40.

    Article  PubMed  CAS  Google Scholar 

  10. Donker M, Drukker CA, Valdes Olmos RA, et al. Guiding breast-conserving surgery in patients after neoadjuvant systemic therapy for breast cancer: a comparison of radioactive seed localization with the ROLL technique. Ann Surg Oncol. 2013;20:2569–72.

    Article  PubMed  Google Scholar 

  11. Espinosa-Bravo M, Sao Avilés A, Esgueva A, et al. Breast-conservative surgery after neoadjuvant chemotherapy in breast cancer patients: comparison of two tumor localization methods. Eur J Surg Oncol. 2011;37:1038–43.

    Article  PubMed  CAS  Google Scholar 

  12. Ramos M, Diez JC, Ramos T, Ruano R, Sancho M, Gonzalez-Orus JM. Intraoperative ultrasound in conservative surgery for non palpable breast cancer after neoadjuvant chemotherapy. Int J Surg. 2014;12:572–7.

    Article  PubMed  CAS  Google Scholar 

  13. Rubio IT, Henry-Tillman R, Klimberg VS. Surgical use of breast ultrasound. Surg Clin North Am. 2003;83:771–88.

    Article  PubMed  Google Scholar 

  14. Krekel NMA, Zonderhuis BM, Stockmann HBAC, et al. A comparison of three methods for nonpalpable breast cancer excision. Eur J Surg Oncol. 2011;37:109–15.

    Article  PubMed  CAS  Google Scholar 

  15. Cox CE, Furman B, Stowell N, et al. Radioactive seed localization breast biopsy and lumpectomy: can specimen radiograph be eliminated? Ann Surg Oncol. 2004;10:1039–47.

    Article  Google Scholar 

  16. Sung JS, King V, Thornton CM, et al. Safety and efficacy of radioactive seed localization with I-125 prior to lumpectomy and/or excisional biopsy. Eur J Radiol. 2013;82:1453–7.

    Article  PubMed  Google Scholar 

  17. Thind CR, Tan S, Desmond S, et al. SNOLL: sentinel node and occult (impalpable) lesion localization in breast cancer. Clin Radiol. 2011;66:833–9.

    Article  PubMed  CAS  Google Scholar 

  18. Lovrics PJ, Goldsmith CH, Hodgson N, et al. A multicenter randomized controlled trial comparing radio-guided seed localization to standard wire localization for nonpalpable, invasive, and in situ breast carcinoma. Ann Surg Oncol. 2011;18:3407–14.

    Article  PubMed  Google Scholar 

  19. Thompson M, Klimberg VS. Use of breast ultrasound in surgery. Surg Clin North Am. 2007;87:469–84.

    Article  PubMed  Google Scholar 

  20. Smith LF, Rubio IT, Henry-Tillman R, et al. Intraoperative ultrasound-guided breast biopsy. Am J Surg. 2000;180:419–23.

    Article  PubMed  CAS  Google Scholar 

  21. Rahusen FD, Bremers AJA, Fabry HFJ, et al. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial. Ann Surg Oncol. 2002;9:994–8.

    Article  PubMed  Google Scholar 

  22. Moore MM, Whitney LA, Cerilli L, Imbrie JZ, Bunch M, Simpson VB, Hanks JB. Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer. Ann Surg. 2001;233:761–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  23. Ahmed M, Douek M. Intraoperative ultrasound versus wire-localization in the surgical management of non palpable breast cancers: systematic review and meta-analysis. Breast Cancer Res Treat. 2013;140:435–46.

    Article  PubMed  CAS  Google Scholar 

  24. Blumencranz PW, Ellis D, Barlowe K. Use of hydrogel breast biopsy tissue markers reduces the need for wire localization. Ann Surg Oncol. 2014;21:3272–7.

    Article  Google Scholar 

  25. Van Riet YE, Maaskant AJ, Creemers GJ, et al. Identification of residual breast tumor localization after neoadjuvant chemotherapy using a radioactive 125 iodine seed. Eur J Surg Oncol. 2010;36:164–9.

    Article  PubMed  Google Scholar 

  26. Gobardhan PD, de Wall LL, van der Laan L, et al. The role of radioactive iodine-125 seed localization in breast-conserving therapy following neoadjuvant chemotherapy. Ann Oncol. 2012;24:668–73.

    Article  PubMed  Google Scholar 

  27. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumors: revised RECIST guidelines (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  PubMed  CAS  Google Scholar 

  28. Ogston KN, Miller ID, Payne S, Hutcheon AW, Sarkar TK, Smith I, Schofield A, Heys SD. A new histological grading system to assess response of breast cancers to primary chemotherapy: prognostic significance and survival. Breast. 2003;12:320–7.

    Article  PubMed  Google Scholar 

  29. Boughey JC, Peintinger F, Meric-Bernstam F, et al. Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg. 2006;244:464–70.

    PubMed  PubMed Central  Google Scholar 

  30. Criscitiello C, Azim HA Jr, Agbor-Tarh D, et al. Factors associated with surgical management following neoadjuvant therapy in patients with primary HER2-positive breast cancer: results from the NeoALTTO phase III trial. Ann Oncol. 2013;24:1980–5.

    Article  PubMed  CAS  Google Scholar 

  31. Debled M, MacGrogan G, Breton-Callu C, et al. Surgery following neoadjuvant chemotherapy for HER2-positive locally advanced breast cancer: time to reconsider the standard attitude. Eur J Cancer. 2015;51:697–704.

    Article  PubMed  Google Scholar 

  32. Kass R, Kumar G, Klimber VS, et al. Clip migration in stereotactic biopsy. Am J Surg. 2002;184:325–31.

    Article  PubMed  Google Scholar 

  33. Krekel NM, Lopes Cardozo AM, Muller S, et al. Optimizing surgical accuracy in palpable breast cancer with intra operative breast ultrasound-feasibility and surgeon’s learning curve. Eur J Surg Oncol. 2011;37:1044–50.

    Article  PubMed  CAS  Google Scholar 

  34. Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–63.

    PubMed  CAS  Google Scholar 

  35. Krekel N, Zonderhuis B, Schreurs H, et al. Ultrasound-guided breast-sparing surgery to improve cosmetic outcomes and quality of life: a prospective multicentre randomized controlled clinical trial comparing ultrasound-guided surgery to traditional palpation-guided surgery (COBALT trial). BMC Surg. 2011;11:8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cochrane RA, Valasiadou P, Wilson AR, et al. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90:1505–9.

    Article  PubMed  CAS  Google Scholar 

  37. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology–American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol. 2014;21:704–16.

    Article  PubMed  Google Scholar 

  38. Truin W, Vugts G, Roumen RM, et al. Differences in response and surgical management with neoadjuvant chemotherapy in invasive lobular versus ductal breast cancer. Ann Surg Oncol. 2015. Epub ahead of print.

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Authors and Affiliations

  1. Breast Surgical Oncology Unit, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Isabel T. Rubio MD, PhD, Antonio Esgueva-Colmenarejo MD & Martin Espinosa-Bravo MD, PhD

  2. Department of Radiology, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Juan Pablo Salazar MD & Ignacio Miranda MD

  3. Department of Pathology, Hospital Universitario Vall d’Hebron, Barcelona, Spain

    Vicente Peg MD, PhD

Authors
  1. Isabel T. Rubio MD, PhD
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  2. Antonio Esgueva-Colmenarejo MD
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  3. Martin Espinosa-Bravo MD, PhD
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  4. Juan Pablo Salazar MD
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  5. Ignacio Miranda MD
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  6. Vicente Peg MD, PhD
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Correspondence to Isabel T. Rubio MD, PhD.

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Rubio, I.T., Esgueva-Colmenarejo, A., Espinosa-Bravo, M. et al. Intraoperative Ultrasound-Guided Lumpectomy Versus Mammographic Wire Localization for Breast Cancer Patients After Neoadjuvant Treatment. Ann Surg Oncol 23, 38–43 (2016). https://doi.org/10.1245/s10434-015-4935-z

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  • DOI: https://doi.org/10.1245/s10434-015-4935-z

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