Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2016; 7(1): 44-53
Published online Feb 10, 2016. doi: 10.5306/wjco.v7.i1.44
Current status of ultrasound-guided surgery in the treatment of breast cancer
José H Volders, Max H Haloua, Nicole MA Krekel, Sybren Meijer, Petrousjka M van den Tol
José H Volders, Gelderse vallei Ziekenhuis, 6716 RP Ede, The Netherlands
Max H Haloua, Nicole MA Krekel, Sybren Meijer, Petrousjka M van den Tol, Department of Surgery, VU Medical Center, 1081 HZ Amsterdam, The Netherlands
Author contributions: Volders JH and van den Tol MP conceived and co-ordinated the study and wrote the paper, they performed the majority of literature research and analyzed current articles; Haloua MH, krekel NMA and Meijer S have been involved in drafting the manuscript and revising it critically for important intellectual content, they performed additional literature research with analysis and interpretation of data; all authors reviewed the results and approved the final version of the manuscript.
Conflict-of-interest statement: The authors whose names are listed above certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus, membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements). The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Petrousjka M van den Tol, Prefessor, Department of Surgery, VU medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
Telephone: +31-20-4444400 Fax: +31-20-4444512
Received: June 1, 2015
Peer-review started: June 2, 2015
First decision: August 7, 2015
Revised: October 12, 2015
Accepted: October 23, 2015
Article in press: October 27, 2015
Published online: February 10, 2016

The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing “blind” surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast tumours in the search for better oncological and cosmetic outcomes.

Keywords: Breast neoplasms, Segmental, Surgery, Ultrasonography, Mastectomy, Cosmetics, Margins, Volume status, Wire localization, Radioguided surgery

Core tip: Despite improved survival and local recurrence rates of breast cancer patients in the past years, there is still much to be gained in surgical treatment. Unacceptable rates of involved margins are described, with up to 25% of the patients undergoing re-excision after breast conserving surgery. The most frequently used excision methods are wire-guided and radioguided localization for non-palpable tumours and palpation-guided localization for palpable tumours. Although ultrasound-guided surgery is a simple and non-invasive technique, it is not frequently used. This review highlights the position of ultrasound-guided surgery for breast cancer in the search for better oncological and cosmetic outcomes.