Intraoperative ultrasound in breast-conserving surgery for palpable breast cancer: Association with surgical margins and resection volume

Accurate determination of surgical margins is a crucial aspect of breast-conserving surgery (BCS) for early-stage breast cancer. Traditionally, tumor localization has been performed through palpation followed by frozen section analysis. However, intraoperative ultrasonography (US) presents a practical and cost-effective alternative, particularly for small or poorly palpable lesions. This study aimed to evaluate the relationship between the use of intraoperative US and surgical outcomes in BCS. We conducted a retrospective analysis of 180 female patients with early-stage breast cancer who underwent surgery from 2020 to 2023, excluding those who received neoadjuvant therapy. Patients were classified into two groups based on the application of intraoperative US. We compared demographic, histopathological, and surgical parameters, including tumor diameter, resection volume, tumor diameter-to-resection volume ratio, closest surgical margin, and the necessity for cavity re-excision. Intraoperative US was utilized in 51.1% of cases (n=92). Tumor size was notably smaller in the intraoperative US group compared to the palpation-guided group (median 15 mm vs. 20 mm, p=0.019). Additionally, the median resection volume was significantly lower in the US group (64.65 cm³ vs. 130.91 cm³, p=0.001). The tumor diameter-to-resection volume ratio was higher in the intraoperative US group (0.03 vs. 0.02, p=0.044), indicating more precise tumor-targeted excision. Cavity re-excision rates were comparable between the two groups (10.9% vs. 15.9%, p=0.482), and no postoperative positive margins were recorded. Intraoperative ultrasonography was associated with adequate surgical margins and reduced resection volumes in breast-conserving surgery, suggesting its potential to enhance tissue preservation without increasing re-excision rates.