Intraoperative ultrasound reduces the need for a second surgery in breast cancer and avoids additional treatments

Positive margins around a breast tumour increase the risk of local recurrence and the possibility of needing additional treatments. This was supported by a pioneering study carried out by a team in the Breast Cancer Area of the Clínica Universidad de Navarra Cancer Centre examining the feasibility of using intraoperative ultrasound as a method to evaluate the superficial margins in patients with breast cancer undergoing a mastectomy.

The results, which were published in the European Journal of Surgical Oncology, showed that using this technique significantly reduced the percentage of positive margins. Specifically, intraoperative ultrasound reduced the percentage of positive margins obtained in a sample of 59 patients with breast cancer from 10% to 0%. At the same time, the cut-off point to determine the need for a new intraoperative excision was identified as being 2 millimetres from the superficial margin.

In recent years, the number of skin-preserving and nipple-areola complex (NAC)-retaining mastectomies with immediate reconstruction have increased. Preservation of the skin and the NAC increases the importance of the superficial margin because, if negative margins are not achieved in surgery, it is exceedingly difficult to operate again. In addition, unnecessary additional treatments can be avoided if the margins are negative.

“As our team has demonstrated in conservative surgeries, the use of intraoperative ultrasound reduces the rate of positive margins and therefore, we decided to start this study to try to demonstrate the effectiveness of intraoperative ultrasound in mastectomies. In this line, it has been seen that most relapses after mastectomy occur in the skin flaps, hence the importance of achieving a surgery with negative margins,” said Dr. Isabel Rubio, coordinator of the Clínica Universidad de Navarra Cancer Centre Breast Cancer Area. This is the first research done in this area to date and involved collecting data from 59 patients treated at the Clinic from 2020 to 2022. 
According to Dr. Rubio, “this study proves that intraoperative ultrasound is a very useful technique that breast surgeons can use to reduce positive margins, save patients additional treatments, and reduce the risk of recurrence.”

Quality in the diagnosis and treatment of breast cancer

On the other hand, Dr. Isabel Rubio received the Extraordinary Award from the ECO Foundation, an organisation formed by Spanish oncologists to globally analyse Oncology and debate guidelines for improvement. The award, which expressly mentions “quality in the diagnosis and treatment of breast cancer,” highlights research in this field of medicine as one of the keys to continue progressing in the fight against cancer.