Our Summary

This study compared two types of surgery for nonpalpable (unable to be felt) breast cancer: ultrasound-guided and wire-guided. The researchers looked at over 500 women who had been diagnosed with nonpalpable breast cancer. The patients were randomly split into two groups: those who had surgery using ultrasound guidance and those who had surgery using a wire guide. The researchers then recorded the rate of second surgeries and the presence of remaining cancer cells at the edges of the removed tissue (positive surgical margins).

The findings showed that the ultrasound-guided group had a lower rate of positive surgical margins (4.6%) compared to the wire-guided group (19.4%). Factors such as age, menopausal status, amount of tissue removed, grade of the tumor, and type of tumor significantly affected the rate of positive surgical margins.

Furthermore, the rate of second surgeries was significantly lower in the ultrasound-guided group compared to the wire-guided group. The study concluded that ultrasound-guided surgery seems to be more effective for treating nonpalpable breast cancers, as it resulted in cleaner removal of the cancer and lower rates of second surgeries. Also, patients who had ultrasound-guided surgery could avoid the discomfort associated with preoperative wire placement.

FAQs

  1. What were the two types of surgery for nonpalpable breast cancer compared in this study?
  2. How did the rates of positive surgical margins and second surgeries compare between the ultrasound-guided group and the wire-guided group?
  3. What were the benefits of ultrasound-guided surgery for treating nonpalpable breast cancers, according to the study?

Doctor’s Tip

A doctor might tell a patient that opting for ultrasound-guided lumpectomy may result in a lower rate of positive surgical margins and a decreased likelihood of needing a second surgery compared to wire-guided lumpectomy. This can lead to a more successful treatment outcome and potentially reduce the need for additional procedures. Additionally, ultrasound-guided surgery may be less uncomfortable for the patient as it eliminates the need for preoperative wire placement.

Suitable For

Patients who are typically recommended lumpectomy are those with nonpalpable breast cancer, especially those who have smaller tumors that can be easily removed with clear margins. Additionally, patients who prefer breast-conserving surgery over mastectomy may also be recommended for lumpectomy. Other factors that may influence the recommendation for lumpectomy include the size and location of the tumor, as well as the patient’s overall health and personal preferences.

Timeline

Before lumpectomy:

  1. Patient undergoes diagnostic tests such as mammograms, ultrasounds, and biopsies to confirm the presence of nonpalpable breast cancer.
  2. Treatment options are discussed with the patient, including lumpectomy as a potential surgical option.
  3. Preoperative planning, which may include marking the area of the tumor for accurate removal during surgery.
  4. Patient may undergo preoperative procedures such as wire placement for wire-guided surgery.

After lumpectomy:

  1. Patient is monitored closely for any complications post-surgery, such as infection or bleeding.
  2. Pathology report is analyzed to determine if all cancer cells were removed during the surgery.
  3. If positive surgical margins are found, further treatment options may be discussed, such as additional surgery or radiation therapy.
  4. Follow-up appointments are scheduled to monitor the patient’s recovery and overall health.
  5. Patient may undergo additional treatments, such as radiation therapy, hormone therapy, or chemotherapy, depending on the characteristics of the tumor and the presence of any remaining cancer cells.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumpectomy include:

  1. What are the differences between ultrasound-guided and wire-guided lumpectomy procedures?
  2. Based on my specific situation, which type of lumpectomy do you recommend for me?
  3. What are the potential risks and benefits of each type of lumpectomy?
  4. How will the choice of lumpectomy procedure affect the likelihood of needing a second surgery or having positive surgical margins?
  5. Are there any specific factors about my tumor or health that make one type of lumpectomy more suitable for me?
  6. What is the recovery process like for each type of lumpectomy?
  7. Will I need any additional imaging or tests before the lumpectomy procedure?
  8. How experienced are you and your team in performing ultrasound-guided lumpectomies?
  9. Are there any alternative treatment options to consider besides lumpectomy?
  10. Can you provide me with more information or resources to help me make an informed decision about my lumpectomy procedure?

Reference

Authors: Hu X, Li S, Jiang Y, Wei W, Ji Y, Li Q, Jiang Z. Journal: J Int Med Res. 2020 Jan;48(1):300060519896707. doi: 10.1177/0300060519896707. PMID: 31937169