Surgeon delivered intra-operative ultrasound: a safe and effective technique to enhance service delivery
Association of Breast Surgery ePoster Library. Vestey S. 05/15/17; 166276; P130
Sarah Vestey
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Abstract
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Introduction
Wire-guided localisation (WGL) is standard for impalpable breast cancers. Surgeon delivered intra-operative USS (IOUS) is an alternative. WGL is resource intensive and uncomfortable. Locally a single imager has four localisation slots per session. With IOUS the surgeon may better appreciate tumour location, but there is no check mammogram. We asked, is it equivalent in terms of safety and quality?
Methods
A 2-year retrospective review (single surgeon) was performed (October 2014-16), comparing outcomes of IOUS to WGL and standard palpable excision (WLE). Surgery took place at two hospital sites (WGL facilities at a third site). IOUS included insertion of Hawkins III wires. We measured tumour characteristics, re-excision rates, pre-operative radiological size, and specimen weight. Complete radiological excision was confirmed by specimen x-ray in all cases.
Results
There were 117 invasive cancers localised, 56 by IOUS, 24 WGL, 83 WLE. Baseline characteristics, specimen weight and pre-operative radiological size were similar between IOUS and WGL groups. Re-excision rates were 21% (12/56) IOUS, 29% (7/24) WGL, 23% (19/83) WLE. A further 6 non-invasive lesions were also successfully localised by IOUS. No additional operating time was required. 15.5 outpatient sessions were freed up for imagers to assess urgent 2WW referrals, equivalent to over 200 outpatient appointments saved.
Conclusions
IOUS was safe. This data suggests a lower re-excision rate for IOUS versus WGL with no excess in specimen size. As well as service delivery and cost advantages, patients were spared a 30-minute journey from the localisation site as well as an improved perioperative journey.
Wire-guided localisation (WGL) is standard for impalpable breast cancers. Surgeon delivered intra-operative USS (IOUS) is an alternative. WGL is resource intensive and uncomfortable. Locally a single imager has four localisation slots per session. With IOUS the surgeon may better appreciate tumour location, but there is no check mammogram. We asked, is it equivalent in terms of safety and quality?
Methods
A 2-year retrospective review (single surgeon) was performed (October 2014-16), comparing outcomes of IOUS to WGL and standard palpable excision (WLE). Surgery took place at two hospital sites (WGL facilities at a third site). IOUS included insertion of Hawkins III wires. We measured tumour characteristics, re-excision rates, pre-operative radiological size, and specimen weight. Complete radiological excision was confirmed by specimen x-ray in all cases.
Results
There were 117 invasive cancers localised, 56 by IOUS, 24 WGL, 83 WLE. Baseline characteristics, specimen weight and pre-operative radiological size were similar between IOUS and WGL groups. Re-excision rates were 21% (12/56) IOUS, 29% (7/24) WGL, 23% (19/83) WLE. A further 6 non-invasive lesions were also successfully localised by IOUS. No additional operating time was required. 15.5 outpatient sessions were freed up for imagers to assess urgent 2WW referrals, equivalent to over 200 outpatient appointments saved.
Conclusions
IOUS was safe. This data suggests a lower re-excision rate for IOUS versus WGL with no excess in specimen size. As well as service delivery and cost advantages, patients were spared a 30-minute journey from the localisation site as well as an improved perioperative journey.
Introduction
Wire-guided localisation (WGL) is standard for impalpable breast cancers. Surgeon delivered intra-operative USS (IOUS) is an alternative. WGL is resource intensive and uncomfortable. Locally a single imager has four localisation slots per session. With IOUS the surgeon may better appreciate tumour location, but there is no check mammogram. We asked, is it equivalent in terms of safety and quality?
Methods
A 2-year retrospective review (single surgeon) was performed (October 2014-16), comparing outcomes of IOUS to WGL and standard palpable excision (WLE). Surgery took place at two hospital sites (WGL facilities at a third site). IOUS included insertion of Hawkins III wires. We measured tumour characteristics, re-excision rates, pre-operative radiological size, and specimen weight. Complete radiological excision was confirmed by specimen x-ray in all cases.
Results
There were 117 invasive cancers localised, 56 by IOUS, 24 WGL, 83 WLE. Baseline characteristics, specimen weight and pre-operative radiological size were similar between IOUS and WGL groups. Re-excision rates were 21% (12/56) IOUS, 29% (7/24) WGL, 23% (19/83) WLE. A further 6 non-invasive lesions were also successfully localised by IOUS. No additional operating time was required. 15.5 outpatient sessions were freed up for imagers to assess urgent 2WW referrals, equivalent to over 200 outpatient appointments saved.
Conclusions
IOUS was safe. This data suggests a lower re-excision rate for IOUS versus WGL with no excess in specimen size. As well as service delivery and cost advantages, patients were spared a 30-minute journey from the localisation site as well as an improved perioperative journey.
Wire-guided localisation (WGL) is standard for impalpable breast cancers. Surgeon delivered intra-operative USS (IOUS) is an alternative. WGL is resource intensive and uncomfortable. Locally a single imager has four localisation slots per session. With IOUS the surgeon may better appreciate tumour location, but there is no check mammogram. We asked, is it equivalent in terms of safety and quality?
Methods
A 2-year retrospective review (single surgeon) was performed (October 2014-16), comparing outcomes of IOUS to WGL and standard palpable excision (WLE). Surgery took place at two hospital sites (WGL facilities at a third site). IOUS included insertion of Hawkins III wires. We measured tumour characteristics, re-excision rates, pre-operative radiological size, and specimen weight. Complete radiological excision was confirmed by specimen x-ray in all cases.
Results
There were 117 invasive cancers localised, 56 by IOUS, 24 WGL, 83 WLE. Baseline characteristics, specimen weight and pre-operative radiological size were similar between IOUS and WGL groups. Re-excision rates were 21% (12/56) IOUS, 29% (7/24) WGL, 23% (19/83) WLE. A further 6 non-invasive lesions were also successfully localised by IOUS. No additional operating time was required. 15.5 outpatient sessions were freed up for imagers to assess urgent 2WW referrals, equivalent to over 200 outpatient appointments saved.
Conclusions
IOUS was safe. This data suggests a lower re-excision rate for IOUS versus WGL with no excess in specimen size. As well as service delivery and cost advantages, patients were spared a 30-minute journey from the localisation site as well as an improved perioperative journey.
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