3-dimensional ultrasound to determine resection margins in breast cancer

Objectives: Resection margins involved by breast cancer cells are the mayor risk factor for local recurrence. Therefore, determination of resection status is a major topic in breast surgery. We hypothesised that 3D-ultrasound is able to determine margins as good as macroscopic pathological examination and frozen section in selected cases.

Methods: Surgery specimens from patients with ductal invasive breast cancer were examined by in vitro 3D-ultrasound after dissection and before pathological examination. Macroscopic pathological examination was performed afterwards, without knowledge of the results from the ultrasound examination. A tumour free margin of 5mm was requested. We analysed our data for indications for addition breast tissue resection by 3D-ultrasound, intraoperative macroscopic and frozen section pathological examination and definitive pathological examination.

Results: 57 breast cancer specimens were analyzed by 3D Ultrasound after dissection in vitro. 22 of these were mastectomies and 35 lumpectomies. At least one tumour free margin of less than 5mm was diagnosed in 27 specimens by ultrasound and in 21 specimens by pathologic examination. Therefore, ultrasound generated 6 false positive cases with margins of more than 5mm on pathological examination but with less than 5mm on ultrasound. Interestingly, no false negative ultrasound case occurred in this preliminary series.

Conclusions: Due to the results of this preliminary series, 3D ultrasound can provide the breast surgeon with additional information on resection margin status in selected cases.