Intraoperative Ultrasound Localization of Nonpalpable Breast Lesions

Background: The use of preoperative wire localization (PWL) for excision of nonpalpable breast lesions has several disadvantages. The purpose of this study was to evaluate the use of intraoperative ultrasound localization (IUL) and to compare it with PWL.

Methods: Twenty-nine patients (22 with cancer) underwent IUL in a solo surgical practice over a 21-month period. They were compared to 22 patients with cancer in the same practice who underwent PWL in a similar time period. Parameters analyzed included accuracy of lesion removal, margin involvement, extent of disease-free margin, and the amount of tissue removed.

Results: The targeted lesions were accurately removed 100% of the time, and disease-free margins were obtained at the first operation in 82% of patients in both groups. An equivalent amount of disease-free margin (IUL, 6.6 mm; PWL, 6.7 mm) was obtained with IUL while removing a smaller (IUL, 62.6 cm3; PWL, 81.1 cm3) mean volume of tissue.

Conclusions: IUL is an accurate method of localizing most nonpalpable mass lesions identified on mammography. Equivalent margin status can be achieved while removing no more tissue than with PWL. The trauma of wire localization in an awake patient is avoided.