Does surgeon-performed intraoperative wire localization allow for lower margin positivity rates compared to radiologist-performed preoperative localization in early breast cancer?

Reeta Asmai; Tess Huy; Jennifer L Baker; Hong-Ho Yang; Carlie K Thompson; Nimmi S Kapoor

doi:10.1016/j.amjsurg.2024.115986

Does surgeon-performed intraoperative wire localization allow for lower margin positivity rates compared to radiologist-performed preoperative localization in early breast cancer?

Am J Surg. 2024 Sep 21:115986. doi: 10.1016/j.amjsurg.2024.115986. Online ahead of print.

Authors

Reeta Asmai¹, Tess Huy¹, Jennifer L Baker¹, Hong-Ho Yang¹, Carlie K Thompson¹, Nimmi S Kapoor²

Affiliations

¹ University of California Los Angeles, David Geffen School of Medicine, Department of Surgery, United States.
² University of California Los Angeles, David Geffen School of Medicine, Department of Surgery, United States. Electronic address: [email protected].

PMID: 39327165
DOI: 10.1016/j.amjsurg.2024.115986

Abstract

Background: This study compares positive margin rates in breast conserving surgery (BCS) for early breast cancer using two localization techniques: surgeon-performed intraoperative ultrasound-guided wire localization (IOWL) versus radiologist-performed preoperative wire localization (POWL).

Methods: Patients with unifocal breast cancer undergoing BCS with follow-up at a single institution were retrospectively identified. Factors associated with positive margins were identified.

Results: 177 patients underwent IOWL (N = 85) or POWL (N = 92). There was a significantly lower rate of positive margins for IOWL vs. POWL (7.1 % vs. 23.9 %, p = 0.002) and a corresponding lower rate of re-excision for IOWL vs. POWL (5.9 % vs. 18.5 %, p = 0.011). Presence of DCIS was associated with positive margins (p = 0.015). After adjusting for presence of DCIS, tumor size, and volume of tissue removed, the positive margin rate was significantly lower in the IOWL group compared to the POWL group (aOR 0.34, 95 % CI 0.13-0.93).

Conclusions: In this study, adjusted analysis favored IOWL in achieving negative tumor margins. Prospective studies are needed to further explore the impact of IOWL on quality, cost-effectiveness, and patient experience.