Sonography of palpable breast cancer

Value of Ultrasound in the Detection of Benign and Malignant Breast Diseases: A Diagnostic Accuracy Study

Objectives

We sought to determine the diagnostic accuracy of ultrasound for benign and malignant breast lesions.

Methods

This retrospective study was performed to evaluate the diagnostic accuracy of ultrasound in 203 patients with complete medical records who visited Mehr Medical Imaging Center for breast ultrasound between March 2014 and February 2016. The collected data comprised of demographic characteristics, ultrasound results (consisting of the anatomic area of the lesion, the involved side, and the ultrasound characteristics of the lesion), mammogram results, and pathology reports (if surgery or biopsy was performed).

Results

For the diagnosis of malignant and benign lesions, ultrasound had a sensitivity of 93.9% and specificity of 86.5%; its positive and negative predictive values were 86.9% and 93.8%, respectively. Lesion type was significantly associated with a family history of breast cancer and fertility status (p < 0.005), but there was no significant association between the involved side and tumor type (p > 0.050).

Conclusions

Mammography is the best technique for screening and identifying patients with non-mass-like breast lesions and microcalcifications. Considering the false positive and false-negative results, ultrasound is not a perfect screening modality. Future studies are recommended to study the value of ultrasound in the detection of high-risk breast cancer patients.

[Exploring a non-inflammatory clinical breast mass: Clinical practice guidelines]

PURPOSE

The aim of the study was to assess the diagnostic value of physical examination, radiologic explorations and percutaneous procedures of the breast in the exploration of a non-inflammatory palpable mass, in order to propose guidelines.

METHOD

A systematic literature review was conducted in the Medline and Cochrane library databases. International guidelines in French and English language were also consulted until April 30th 2015.

RESULTS

Physical examination of a non-inflammatory palpable breast mass is not sufficient to eliminate a breast cancer (LE2). Mammography alone has a sensitivity between 70 and 95% for the diagnosis of breast cancer (LE3). Echography alone has a sensitivity of 98 to 100% for the diagnosis of breast cancer (LE2). The core needle biopsy has a better sensitivity and specificity than the fine-needle aspiration for breast cancer diagnosis (LE2). The association of mammography and 2D echography presents excellent sensitivity and negative predictive value (close to 100 %) to exclude a breast cancer (LE3). A double evaluation using mammography and echography is recommended in the exploration of a non-inflammatory palpable breast mass (grade B).

Ultrasonography-guided breast-conserving surgery is superior to palpation-guided surgery for palpable breast cancer

INTRODUCTION

The aim of this study was to determine the efficacy of ultrasonography (US)-guided excision of palpable breast cancer and to compare it with the standard palpation-guided breast-conserving surgery (BCS).

METHODS

For this purpose, 335 women with palpable breast cancer who underwent BCS were retrospectively studied. The positive surgical margins and re-excision rates were investigated.

RESULTS

Of the total cohort, 137 patients were treated with palpation-guided BCS and 198 underwent US-guided tumor excision. The tumor and patient characteristics were similar in both groups. Patient age, postmenopausal status, tumor size, histological grade, intraductal tumor component, lobular histology, and palpation-guided tumor excision were associated with increased risk of positive margins. The shave margins were re-excised at the time of original operation more often by palpation-guided localization (28.5%) than by the US-guided procedure (11.1%) (P < .0001). A surgeon was able to correctly identify the "problematic" margin in 81.1% of cases via intraoperative US and in only 17.9% via palpation (P < .0001). The re-excision rate during a second operation was significantly reduced by US-guided tumorectomy (P = .004). Of 198 patients in the US-guided group, 23 (11.6%) underwent a second operation, as did 33 of 137 patients in the palpation group (24.1%). The sensitivity and specificity of US-guided excisions were 52.7% and 97.5%, respectively, whereas the sensitivity and the specificity of palpation-guided tumor excisions were 15.5% and 65.9%, respectively.

CONCLUSION

US-guided BCS is superior to palpation-guided excision in predicting the closest margins, obtaining clear surgical margins, and reducing re-operations.

Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses

PURPOSE

To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses.

MATERIALS AND METHODS

From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-to-fat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined.

RESULTS

Median participant age was 50 years; 289 of 939 (30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303 (2.6%) BI-RADS category 3 masses, 18 of 193 (9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57 (74%) category 4c lesions, and 180 of 187 (96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specificity improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962 (P=.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P<.001 for both), without significant improvement in sensitivity or AUC.

CONCLUSION

Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.

Screening and diagnosis of breast cancer in low-resource countries: what is state of the art?

Breast cancer is the most common type of cancer in women worldwide; there has been a significant increase in the incidence of breast cancer in low-resource countries, with a disproportionately greater mortality rate compared to high-resource countries attributed to a lack of public awareness of the disease, absence of organized screening programs, and lack of accessible and effective treatment options. Mammography is not a cost-effective or a feasible option for screening and early detection of breast cancer in low-resource countries. A triple test assessment approach of screening clinical breast examination, diagnostic breast ultrasound, and ultrasound-guided fine-needle aspiration cytology may be a feasible option for the early detection of breast cancer.

Optimising surgical accuracy in palpable breast cancer with intra-operative breast ultrasound--feasibility and surgeons' learning curve

AIMS

To evaluate if intra-operative guidance with ultrasonography (US) could improve surgical accuracy of palpable breast cancer excision, and to evaluate the performance of surgeons during training for US-guided excision.

MATERIALS AND METHODS

Thirty female patients undergoing breast-conserving surgery for palpable T1-T2 invasive breast cancer were recruited. Three individual breast surgeons, assisted by US, targeted and excised the tumours. The main objective was to obtain adequate resection margins with optimal resection volumes. The specimen volume, tumour diameter and histological margin status were recorded. The specimen volume was divided by the optimal resection volume, defined as the spherical tumour volume plus a 1.0-cm margin. The resulting calculated resection ratio (CRR) indicated the amount of excess tissue resected.

RESULTS

All tumours were correctly identified during surgery, 29 of 30 tumours (96.7%) were removed with adequately negative margins, and one tumour was removed with focally positive margins. The median CRR was 1.0 (range, 0.4-2.8), implying optimal excision volume. For all breast surgeons, CRR improved during the training period. By the 8th procedure, all surgeons showed proficiency in performing intra-operative breast US.

CONCLUSION

Surgeons can easily learn the skills needed to perform intra-operative US for palpable breast tumour excision. The technique is non-invasive, simple, safe and effective for obtaining adequate resection margins. Within the first two cases, resections reached optimal volumes, thereby, presumably resulting in improved cosmetic outcomes. In a multicentre, randomised, clinical trial, intra-operative US guidance for palpable breast tumours will be evaluated for oncological and cosmetic outcomes.

A comparison of three methods for nonpalpable breast cancer excision

AIMS

To evaluate the efficacy of three methods of breast-conserving surgery (BCS) for nonpalpable invasive breast cancer in obtaining adequate resection margins and volumes of resection.

MATERIALS AND METHODS

A total of 201 consecutive patients undergoing BCS for nonpalpable invasive breast cancer between January 2006 and 2009 in four affiliated institutions was retrospectively analysed. Patients with pre-operatively diagnosed primary or associated ductal carcinoma in situ (DCIS), multifocal disease, or a history of breast surgery or neo-adjuvant treatment were excluded from the study. The resections were guided by wire localisation (WL), ultrasound (US), or radio-guided occult lesion localisation (ROLL). The pathology reports were reviewed to determine oncological margin status, as well as tumour and surgical specimen sizes. The optimal resection volume (ORV), defined as the spherical tumour volume with an added 1.0-cm margin, and the total resection volume (TRV), defined as the corresponding ellipsoid, were calculated. By dividing the TRV by the ORV, a calculated resection ratio (CRR) was determined to indicate the excess tissue resection.

RESULTS

Of all 201 excisions, 117 (58%) were guided by WL, 52 (26%) by US, and 32 (16%) by ROLL. The rate of focally positive and positive margins for invasive carcinoma was significantly lower in the US group (N = 2 (3.7%)) compared to the WL (N = 25 (21.3%)) and ROLL (N = 8 (25%)) groups (p = 0.023). The median CRRs were 3.2 (US), 2.8 (WL) and 3.8 (ROLL) (WL versus ROLL, p < 0.05), representing a median excess tissue resection of 3.1 times the optimal resection volume.

CONCLUSION

US-guided BCS for nonpalpable invasive breast cancer was more accurate than WL- and ROLL-guided surgery because it optimised the surgeon's ability to obtain adequate margins. The excision volumes were large in all excision groups, especially in the ROLL group.

[Diagnostic imaging in oncology--evidence reviews for evidence based guidelines by the Agency of Quality for Medicine (ÄZQ)]

Within the context of the development of evidence-based oncology guidelines, the Agency for Quality in Medicine undertook evidence reviews for diagnostic imaging procedures. Systematic searches retrieved no randomised controlled trials, but only cohort studies and case series of mostly moderate quality. The identified studies provided only a restricted basis for the guideline recommendations as their validity was limited and only outcomes of diagnostic accuracy were examined. However, decision criteria for recommending diagnostic strategies significantly comprise judgements about required resources and availability of diagnostic imaging procedures. These criteria as well as patient out-comes were mostly implicit and should be explicated in future. In order to increase the relevance of evidence reviews for oncological diagnosis, high quality studies which examine resources and patient-centred outcomes for diagnostic strategies are required.

Sonographically occult screen detected breast masses: a retrospective analysis of cases undergoing biopsy

OBJECTIVE

The purpose of this study was to evaluate nonpalpable breast masses identified on mammograms that are sonographically occult.

METHODS

The pathology data base at the Woman's Place for Breast Care of the Woman's Hospital of Texas was searched to identify patients who had undergone biopsy for a nonpalpable breast mass identified on mammograms in which a mass was not visible at sonography.

RESULTS

There were 32 of 231 such nonpalpable masses that were sonographically occult. Twenty-eight of the masses were histologically benign; four were malignant.

CONCLUSION

A small percentage of mammographically visible nonpalpable breast masses are sonographically occult; a majority of these masses are benign. However, biopsy of such masses should be considered and the decision to biopsy based on mammographic features and interval change.

ACR Appropriateness Criteria® on Palpable Breast Masses

Palpable breast masses may become evident during breast self-examination or clinical breast examination or retrospectively after screening mammography. Because most breast masses do not exhibit distinctive physical findings, imaging evaluation is almost always necessary to characterize the lesions and screen the reminder of both breasts. Depending on age, the primary imaging evaluation of a palpable breast mass is mammography or breast ultrasound. Negative imaging results should not deter the biopsy of a clinically suspicious breast mass.

Operator dependence of physician-performed whole-breast US: lesion detection and characterization

PURPOSE

To prospectively examine operator dependence of lesion detection, description, and interpretation when experienced breast radiologists perform whole-breast ultrasonography (US).

MATERIALS AND METHODS

Institutional review board approval was obtained for the HIPAA-compliant study. Ten women (aged 19-53 years; mean, 37.4 years; 20 breasts) with numerous known breast lesions consented to participate. Eleven breast radiologists, who passed experience and qualification requirements for a screening breast US trial and consented to participate, scanned both breasts in all participants and documented images of each detected lesion and its size, location, features, palpability, and Breast Imaging Reporting and Data System final assessment. Intraclass correlation coefficients (ICCs) were used to measure agreement on lesion size and location, and kappa statistics were calculated for agreement on features and final assessments compared with consensus.

RESULTS

Eighty-eight unique lesions were identified by at least two investigators (five to 13 lesions per participant). Mean diameter was 6.7 mm (standard error, 0.4; range, 2-22 mm), and eight lesions (9%) were palpable. Of 968 potential detections (88 lesions, 11 investigators), 536 (55%) detections were made. Individual investigators detected between 43 (49%) and 58 (66%) lesions. Larger lesions were more consistently detected: Detection rates were six of 33 lesions (18%) at 3 mm or smaller; 164 of 374 (43.9%) at 3.1-5 mm; 145 of 275 (52.7%) at 5.1-7 mm; 119 of 176 (67.6%) at 7.1-9 mm; 38 of 44 (86%) at 9.1-11 mm; and 64 of 66 (97%) lesions larger than 11 mm (P < .001). ICCs for clockface, distance from nipple, and individual lesion diameter all exceeded 0.7, indicating high reliability. For shape, margins, and final assessments of solid lesions, kappa values were 0.62, 0.67 (substantial agreement), and 0.52 (moderate agreement), respectively. Of 110 detections of consensus cysts 8 mm and smaller, 15 (14%) detections were considered to be of solid lesions by at least one reader.

CONCLUSION

Larger lesions (>11 mm) are most consistently detected, with fewer than half of lesions 5 mm or smaller in mean diameter identified; substantial agreement was found for description of lesion size, location, and key features, and moderate agreement was found for lesion management.

Sonography of Palpable Breast Masses

Ultrasound use should be considered in most instances of a palpable breast finding, particularly in young women. A primary advantage is the ability to directly correlate the physical exam finding with imaging. Ultrasound is useful in characterizing palpable masses as well as detecting cancer in women with negative mammograms. The negative-predictive value of imaging for cancer in the evaluation of a palpable lump is very high, which may reassure women with low-suspicion palpable findings. Short-term follow-up of a palpable mass with benign features may be feasible, though further study is needed to establish criteria. A suspicious dominant palpable finding should be further evaluated even if imaging is negative.

Negative Predictive Value of Sonography and Mammography in Patients with Focal Breast Pain

The purpose of this study was to determine the negative predictive value of mammography and sonography in a population of patients with focal breast pain referred for imaging evaluation. Eighty-six consecutive patients with focal breast pain in the absence of a breast mass were retrospectively identified from an imaging database. The electronic inpatient and outpatient records for the 86 patients were reviewed. For patients who were diagnosed with breast cancer, pathology reports were reviewed to determine whether the painful area corresponded to the patient's cancer. In addition, patient records were linked to the institution's cancer registry. Of the 86 patients, 26 patients were lost to follow-up and did not appear in the institution's cancer registry. Four patients were diagnosed with breast carcinoma, two of whom had incidental cancers that were detected mammographically by microcalcifications and were separate from and unrelated to the area of pain. Seven patients underwent biopsy at the site of breast pain with benign diagnosis. Imaging and clinical follow-up for the 51 patients with benign or negative imaging at the site of pain showed no abnormality with a mean follow-up of 26.5 months. The negative predictive value of mammography and sonography in patients with breast pain was 100%. The negative predictive value of mammography and sonography for focal breast pain is high. Negative mammography and sonography can be reassuring to the treating clinician if follow-up is planned when physical examination is not suspicious. However, if physical examination is suspicious, biopsy should not be delayed.

Does ultrasound core breast biopsy predict histologic finding on excisional biopsy?

BACKGROUND

The purpose of this study was to determine whether ultrasound-guided core breast biopsy accurately predicts the histologic finding of a subsequent excisional procedure.

METHODS

Data were collected prospectively from 1997 to 2001 for 832 ultrasound-guided core breast biopsies (USB) that were followed by excisional breast procedure (EP) within 1 year at our institution. The principal histologic finding obtained at USB and EP was identified for each procedure and the degree of agreement was assessed.

RESULTS

The USB histology predicted EP histology in 90% (n = 746) of the procedures. The USB histology was more significant than EP histology in 3% (n = 22) of procedures; USB histology underdetermined EP histology in 7% (n = 64) of procedures. Overall, our results indicate moderate agreement between the principal histology identified at USB relative to that identified at EP.

CONCLUSIONS

Ultrasound-guided core breast biopsy is an effective diagnostic method, but sampling limitations do exist.

Palpable breast lesions: utility of Doppler sonography for diagnosis of malignancy

This study was designed to find whether there are any differences between benign and malignant palpable breast lesions as they are seen on grey-scale and colour-Doppler and on power-Doppler sonography; to determine which variables for each technique are most helpful in distinguishing any such differences; and to see whether the use of an echo-enhancing agent gives better results in the differential diagnosis. Forty-five palpable breast lesions (16 benign and 29 malignant) were evaluated in a preoperative study using grey-scale sonography, colour-Doppler sonography and power-Doppler sonography before and after administration of an echo-enhancing agent (Levovist). We reached the following conclusions: (1) In the grey-scale ultrasound study of palpable breast lesions the presence of microcalcifications, acoustic shadowing and non-well-defined margins are related to malignancy. (2) Colour- and power-Doppler sonography may help in the differential diagnosis. (3) The use of an echo enhancer (Levovist) accentuates these differences and enables them to be noted in other variables, such as pulsatility index, nodule-to-vascularity ratio and number of poles.

Normal mammography and ultrasonography in the setting of palpable breast cancer

BACKGROUND

Each year thousands of women present to general surgeons with palpable breast masses, some of which are clinically ambiguous and the majority of which are benign. In addition, surgeons are frequently faced with the question of whether to biopsy those palpable abnormalities in the setting of normal radiographic studies. One might propose that such lesions could be safely observed rather than immediately biopsied. If these lesions were not biopsied, how many cancers would escape detection? To address this issue, a population of patients with known, palpable breast cancer was retrospectively examined to determine the frequency of normal or benign findings on both mammography and ultrasonography.

METHODS

Between January 1998 and December 2001, 351 women with breast carcinoma presented initially with palpable tumors. The medical records of these remaining 351 cases were retrospectively reviewed to examine the radiographic characteristics of the palpable carcinomas.

RESULTS

Of the 351 cases in the study group, 13 (3.7%) patients with palpable breast cancers had mammogram and sonogram examinations that were both normal, benign, or nonspecific in appearance.

CONCLUSIONS

The results of this study indicate that nearly 4% of women with breast cancer who present with palpable lumps will have normal or benign findings on both mammography and ultrasonography. These data support prior studies of similar false negative rates and may provide some reassurance to surgeons and patients regarding clinical breast lumps, as the decision of whether to biopsy still rests in the surgeon's hands. However, inappropriate reliance on these tests for an evaluation of a palpable abnormality will result in a number of missed tumors.

Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities of the breast

OBJECTIVE

To evaluate the role of combined mammographic and sonographic imaging in patients with palpable abnormalities of the breast.

METHODS

Four hundred eleven consecutive cases of palpable abnormalities of the breast underwent combined mammographic and sonographic evaluation. Patients who did not undergo biopsy had imaging and clinical follow-up; the mean follow-up period was 28.9 months (range, 24-33 months).

RESULTS

One hundred sixty-five (40.1%) of 411 palpable abnormalities had a benign assessment; 97 (58.7%) of the 165 benign lesions were visible on both mammography and sonography; 66 (40%) of 165 benign lesions were mammographically occult and identified at sonographic evaluation. In 60 (14.6%) of the 411 cases, imaging evaluation resulted in a suspicious assessment; 49 (81.7%) of the 60 lesions categorized as suspicious underwent biopsy; 14 (28.5%) of 49 lesions were histologically proved to be carcinoma. Nineteen (31.6%) of the 60 lesions categorized as suspicious were mammographically occult and identified only on sonography; 14 (73.7%) of these 19 lesions underwent biopsy; 12 (63.1%) of 19 were benign, and 2 (10.5%) were malignant. One hundred eighty-six (45.2%) of the 411 palpable abnormalities had negative imaging assessment findings; 12 patients with negative imaging findings underwent biopsy, and all had benign findings. The sensitivity (14 of 14) and negative predictive value (186 of 186) for a combined mammographic and sonographic assessment were 100%; the specificity was 80.1% (186 of 232).

CONCLUSIONS

Cancer was diagnosed in 14 (3.4%) of 411 women who underwent combined imaging for palpable abnormalities of the breast. Combined mammographic and sonographic assessment was shown to be very helpful in identifying benign as well as malignant lesions causing palpable abnormalities of the breast.

Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast

OBJECTIVE

To evaluate the value of combined negative sonographic and mammographic findings in patients with palpable breast abnormalities.

METHODS

One hundred seventy-two patients with 186 palpable abnormalities who had combined negative sonographic and mammographic findings were prospectively studied. Patients who did not undergo biopsy had imaging and clinical follow-up; the mean follow-up period was 28.9 months (range, 24-33 months).

RESULTS

Twelve patients underwent biopsy; benign histologic diagnoses were reported in all 12 (12 [6.9%] of 172). In the remaining 160 patients who were followed, there was no interval development of breast cancer at the site of the palpable abnormality. The negative predictive value of combined negative mammographic and sonographic findings in a patient with a palpable abnormality of the breast was 100%.

CONCLUSIONS

Our findings suggest that in a patient with a palpable abnormality of the breast, the negative predictive value of combined normal sonographic and mammographic findings is very high and is therefore reassuring to the patient.

Acute lymphoblastic leukemia relapse in the breast diagnosed with gray-scale and color Doppler sonography

Extramedullary relapses of acute lymphoblastic leukemia (ALL) in children and young adults are rare and in most cases are localized in the central nervous system, testes, or both. We describe a rare case of extramedullary relapse of ALL in the breast of a 17-year-old girl. The patient, who had been diagnosed with ALL 1 year before and had been in complete remission for 5 months, was admitted to the hospital for investigation of a mass in her left breast. On clinical examination, she had a large, palpable, nontender mass in her left breast. Mammography revealed a very dense mass. On gray-scale and power Doppler sonography, the appearance of the mass was consistent with malignancy. Histopathologic examination of a surgical biopsy specimen permitted accurate diagnosis of ALL.

The role of ultrasonography as an adjunct to mammography in the detection of breast cancer. a systematic review

The aim of this review was to summarise the diagnostic performance of ultrasonography as an adjunct to mammography in the detection of breast cancer and to identify clinical indications. A systematic review was performed of all publications in MEDLINE and EMBASE between 1990 and 2000 on the role of ultrasonography as an adjunct to mammography. 22 studies were included, showing a large variety of indications for ultrasonography and variations in the diagnostic performance of mammography and ultrasonography. There were six studies comparing a combined diagnosis of mammography and ultrasonography together with mammography alone, of which three studies had an increased sensitivity at the cost of a lower specificity. The methods of selecting the study population and interpretation of ultrasonography significantly influenced the diagnostic performance of mammography and ultrasonography relative to each other (P=0.003, P=0.03, respectively). Based on the studies reviewed, little evidence-based support was found to confirm the well recognised value of ultrasonography as an adjunct to mammography in the detection of breast cancer in clinical practice. Furthermore, no clinical indications for additional ultrasonography could be defined. The heterogeneity in the diagnostic performance in these studies may be explained by the methods of patient selection and ultrasonography interpretation, as well as by their poor quality.

Ultrasound-guided core needle biopsy as an initial diagnostic test for palpable breast masses

PURPOSE

To determine the role of ultrasound (US)-guided core needle biopsy as an initial diagnostic test for palpable breast masses.

MATERIALS AND METHODS

Ninety-eight consecutive patients, each with a palpable breast mass, were referred for US-guided core biopsy by a multidisciplinary team of physicians who specialize in the care of breast diseases. All palpable breast masses were clearly visible on high-resolution US. Ninety-nine core needle biopsies were performed under local anesthesia with use of freehand technique, mostly in an outpatient setting. Core needle path through each mass was documented in two orthogonal sections. A mean of 3.4 tissue core samples (range, 1-7) were obtained in each patient.

RESULTS

Core needle biopsy resulted in the diagnosis of 66 malignancies, two cases of atypical ductal hyperplasia (ADH), and 30 benign diseases of the breast. Surgery with curative intent was performed in 63 breast malignancies and excisional biopsies were performed for 10 benign diseases (two cases of ADH and eight benign lesions). Twenty-five breast masses were managed nonoperatively: chemotherapy was performed in three locally advanced breast cancers and 3-year follow-up was conducted for 22 benign lesions. Malignancies were correctly diagnosed in all cases. No malignancy was discovered at surgery or during clinical follow-up of ADH and no benign breast lesions were diagnosed by core needle biopsy. US-guided core needle biopsy is 100% sensitive and specific for palpable breast malignancies, with no false-positive results. A puncture site ecchymosis was the only morbidity or complication noted.

CONCLUSION

US-guided core needle biopsy is a safe and accurate first diagnostic test for palpable breast masses that require tissue proof.

Intraoperative ultrasound is associated with clear lumpectomy margins for palpable infiltrating ductal breast cancer

OBJECTIVE

To evaluate the efficacy of intraoperative ultrasound in obtaining adequate surgical margins in women undergoing lumpectomy for palpable breast cancer.

SUMMARY BACKGROUND DATA

Adequacy of surgical margins is a subject of debate in the literature for women undergoing breast-conserving therapy. The emerging technology of intraoperative ultrasound-guided surgery lends itself well to a prospective study evaluating surgical accuracy and margin status after lumpectomy.

METHODS

Two groups of women undergoing lumpectomy for palpable breast cancer were studied, one group using intraoperative ultrasound (n = 27) and the other without (n = 24). Pathologic specimens were evaluated for size, margins, and accuracy, and patients were questioned about satisfaction with cosmetic results.

RESULTS

Surgical accuracy was improved with intraoperative ultrasound-guided surgery. Margin status was improved, patient satisfaction was equivalent, and cost was not affected using ultrasound technology. Intraoperative ultrasound appears especially efficacious for women whose preoperative mammogram shows dense parenchyma surrounding the lesion.

CONCLUSIONS

The use of ultrasound-guided surgery optimizes the surgeon's ability to obtain satisfactory margins for breast-conserving techniques in patients with breast cancer. Patient satisfaction is excellent and a cost savings is most likely realized.