Cargando…
Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT)
BACKGROUND: Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). OBJECTIVE: The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfactio...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2015
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695494/ https://www.ncbi.nlm.nih.gov/pubmed/26486999 http://dx.doi.org/10.1245/s10434-015-4906-4 |
_version_ | 1782407648581255168 |
---|---|
author | Haloua, Max H. Volders, José H. Krekel, Nicole M. A. Lopes Cardozo, Alexander M. F. de Roos, Wifred K. de Widt-Levert, Louise M. van der Veen, Henk Rijna, Herman Bergers, Elisabeth Jóźwiak, Katarzyna Meijer, Sybren van den Tol, M. Petrousjka |
author_facet | Haloua, Max H. Volders, José H. Krekel, Nicole M. A. Lopes Cardozo, Alexander M. F. de Roos, Wifred K. de Widt-Levert, Louise M. van der Veen, Henk Rijna, Herman Bergers, Elisabeth Jóźwiak, Katarzyna Meijer, Sybren van den Tol, M. Petrousjka |
author_sort | Haloua, Max H. |
collection | PubMed |
description | BACKGROUND: Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). OBJECTIVE: The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS). METHODS: A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either USS (65 patients) or PGS (69 patients). Cosmetic outcomes were assessed by a three-member panel using computerized software Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and by patient self-evaluation, including patient satisfaction. Time points for follow-up were 3, 6, and 12 months after surgery. Overall cosmetic outcome and patient satisfaction were scored on a 4-point Likert scale (excellent, good, fair, or poor), and outcomes were analyzed using a multilevel, mixed effect, proportional odds model for ordinal responses. RESULTS: Ultrasound-guided breast-conserving surgery achieved better cosmetic outcomes, with 20 % excellence overall and only 6 % rated as poor, whereas 14 % of PGS outcomes were rated excellent and 13 % as poor. USS also had consistently lower odds for worse cosmetic outcomes (odds ratio 0.55, p = 0.067) than PGS. The chance of having a worse outcome was significantly increased by a larger lumpectomy volume (p(trend) = 0.002); a volume >40 cc showed odds 2.78-fold higher for a worse outcome than a volume ≤40 cc. USS resulted in higher patient satisfaction compared with PGS. CONCLUSION: Ultrasound-guided breast-conserving surgery achieved better overall cosmetic outcomes and patient satisfaction than PGS. Lumpectomy volumes >40 cc resulted in significantly worse cosmetic outcomes. |
format | Online Article Text |
id | pubmed-4695494 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-46954942016-01-07 Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT) Haloua, Max H. Volders, José H. Krekel, Nicole M. A. Lopes Cardozo, Alexander M. F. de Roos, Wifred K. de Widt-Levert, Louise M. van der Veen, Henk Rijna, Herman Bergers, Elisabeth Jóźwiak, Katarzyna Meijer, Sybren van den Tol, M. Petrousjka Ann Surg Oncol Breast Oncology BACKGROUND: Ultrasound-guided breast-conserving surgery (USS) results in a significant reduction in both margin involvement and excision volumes (COBALT trial). OBJECTIVE: The aim of the present study was to determine whether USS also leads to improvements in cosmetic outcome and patient satisfaction when compared with standard palpation-guided surgery (PGS). METHODS: A total of 134 patients with T1–T2 invasive breast cancer were included in the COBALT trial (NTR2579) and randomized to either USS (65 patients) or PGS (69 patients). Cosmetic outcomes were assessed by a three-member panel using computerized software Breast Cancer Conservative Treatment cosmetic results (BCCT.core) and by patient self-evaluation, including patient satisfaction. Time points for follow-up were 3, 6, and 12 months after surgery. Overall cosmetic outcome and patient satisfaction were scored on a 4-point Likert scale (excellent, good, fair, or poor), and outcomes were analyzed using a multilevel, mixed effect, proportional odds model for ordinal responses. RESULTS: Ultrasound-guided breast-conserving surgery achieved better cosmetic outcomes, with 20 % excellence overall and only 6 % rated as poor, whereas 14 % of PGS outcomes were rated excellent and 13 % as poor. USS also had consistently lower odds for worse cosmetic outcomes (odds ratio 0.55, p = 0.067) than PGS. The chance of having a worse outcome was significantly increased by a larger lumpectomy volume (p(trend) = 0.002); a volume >40 cc showed odds 2.78-fold higher for a worse outcome than a volume ≤40 cc. USS resulted in higher patient satisfaction compared with PGS. CONCLUSION: Ultrasound-guided breast-conserving surgery achieved better overall cosmetic outcomes and patient satisfaction than PGS. Lumpectomy volumes >40 cc resulted in significantly worse cosmetic outcomes. Springer US 2015-10-20 2016 /pmc/articles/PMC4695494/ /pubmed/26486999 http://dx.doi.org/10.1245/s10434-015-4906-4 Text en © The Author(s) 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Breast Oncology Haloua, Max H. Volders, José H. Krekel, Nicole M. A. Lopes Cardozo, Alexander M. F. de Roos, Wifred K. de Widt-Levert, Louise M. van der Veen, Henk Rijna, Herman Bergers, Elisabeth Jóźwiak, Katarzyna Meijer, Sybren van den Tol, M. Petrousjka Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT) |
title | Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT) |
title_full | Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT) |
title_fullStr | Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT) |
title_full_unstemmed | Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT) |
title_short | Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial (COBALT) |
title_sort | intraoperative ultrasound guidance in breast-conserving surgery improves cosmetic outcomes and patient satisfaction: results of a multicenter randomized controlled trial (cobalt) |
topic | Breast Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695494/ https://www.ncbi.nlm.nih.gov/pubmed/26486999 http://dx.doi.org/10.1245/s10434-015-4906-4 |
work_keys_str_mv | AT halouamaxh intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT voldersjoseh intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT krekelnicolema intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT lopescardozoalexandermf intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT derooswifredk intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT dewidtlevertlouisem intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT vanderveenhenk intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT rijnaherman intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT bergerselisabeth intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT jozwiakkatarzyna intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT meijersybren intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt AT vandentolmpetrousjka intraoperativeultrasoundguidanceinbreastconservingsurgeryimprovescosmeticoutcomesandpatientsatisfactionresultsofamulticenterrandomizedcontrolledtrialcobalt |