Ultrasound best for margin assessment during breast surgery: Study
Denmark: Findings from a research showed diagnostic ultrasound to the best imaging method for assessing margins of cancers being excised during breast-conserving surgery.
"Ultrasound demonstrated the highest and radiography the lowest diagnostic performance for the assessment of intraoperative margin," Irina Palimaru Manhoobi, Department of Radiology, (I.P.M., S.R.), Aarhus University Hospital, Denmark, and the team wrote in the journal Academic Radiology.
It is challenging to achieve adequate resection margins in breast conserving surgery and often demands more than one surgery. Considering this, Dr. Palimaru Manhoobi and colleagues aimed to evaluate pooled diagnostic sensitivity, and specificity of radiological methods for intraoperative margin assessment and their impact on repeat surgery rate.
The studies using digital breast tomosynthesis (DBT), radiography, micro-CT, and ultrasound for intraoperative margin assessment with the histological assessment as the reference method were included. The researchers performed a systematic search of online databases. The studies were screened for eligibility criteria by two investigators who extracted data of the included studies independently. They used the quality assessment on diagnostic accuracy studies (QUADAS)-2 tool.
The systematic search resulted in screening of 798 unique records. For meta-analysis, twenty-two articles with 29 radiological imaging methods were selected for meta-analysis.
Salient findings of the study include:
- Pooled sensitivity and specificity and area under the curve were calculated for each of the 4 subgroups in the meta-analysis respectively: Radiography; 52%, 77%, 60%, DBT; 67%, 76%, 76%, micro-CT; 68%, 69%, 72%, and ultrasound; 72%, 78%, 80%.
- The repeat surgery rate was poorly reported in the included studies.
"Ultrasound was shown to have the highest and radiography the lowest diagnostic performance for intraoperative margin assessment. However, there was a high heterogeneity between studies and the subgroups were small," the team wrote.
"The radiological methods for margin assessment need further improvement to provide reliable guidance in the clinical workflow and to prevent repeat surgeries," they concluded.
Reference:
The study titled, "Diagnostic accuracy of radiography, digital breast tomosynthesis, micro-CT and ultrasound for margin assessment during breast surgery: A systematic review and meta-analysis," was published in the journal Academic Radiology.
