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Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective
BACKGROUND: Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation. ME...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418593/ https://www.ncbi.nlm.nih.gov/pubmed/34448055 http://dx.doi.org/10.1245/s10434-021-10454-8 |
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author | Chakedis, Jeffery M. Tang, Annie Kuehner, Gillian E. Vuong, Brooke Lyon, Liisa L. Romero, Lucinda A. Raber, Benjamin M. Mortenson, Melinda M. Shim, Veronica C. Datrice-Hill, Nicole M. McEvoy, Jennifer R. Arasu, Vignesh A. Wisner, Dorota J. Chang, Sharon B. |
author_facet | Chakedis, Jeffery M. Tang, Annie Kuehner, Gillian E. Vuong, Brooke Lyon, Liisa L. Romero, Lucinda A. Raber, Benjamin M. Mortenson, Melinda M. Shim, Veronica C. Datrice-Hill, Nicole M. McEvoy, Jennifer R. Arasu, Vignesh A. Wisner, Dorota J. Chang, Sharon B. |
author_sort | Chakedis, Jeffery M. |
collection | PubMed |
description | BACKGROUND: Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation. METHODS: The study identified breast cancer patients with BCS from 1 January to 31 October 2015 and from 1 January to 31 October 2019. Clinicopathologic characteristics were collected, and localization types were categorized. Clinical outcomes were analyzed, including localization use, surgeon adoption of IUS, day-of-surgery intervals, and re-excision rates. Multivariate logistic regression analysis was performed to evaluate predictors of re-excision. RESULTS: The number of BCS procedures increased 23%, from 1815 procedures in 2015 to 2226 procedures in 2019. The IUS rate increased from 4% of lumpectomies (n = 79) in 2015 to 28% of lumpectomies (n = 632) in 2019 (p < 0.001). Surgeons using IUS increased from 6% (5 of 88 surgeons) in 2015 to 70% (42 of 60 surgeons) in 2019. In 2019, 76% of IUS surgeons performed at least 25% of lumpectomies with IUS. The mean time from admission to incision was shorter with IUS or seed localization than with wire localization (202 min with IUS, 201 with seed localization, 262 with wire localization in 2019; p < 0.001). The IUS re-excision rates were lower than for other localization techniques (13.6%, vs 19.6% for seed localization and 24.7% for wire localization in 2019; p = 0.006), and IUS predicted lower re-excision rates in a multivariable model (odds ratio [OR], 0.59). CONCLUSIONS: In a high-volume integrated health system, IUS was adopted for BCS by a majority of surgeons. The use of IUS decreased the time from admission to incision compared with wire localization, and decreased re-excision rates compared with other localization techniques. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-021-10454-8. |
format | Online Article Text |
id | pubmed-8418593 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-84185932021-09-22 Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective Chakedis, Jeffery M. Tang, Annie Kuehner, Gillian E. Vuong, Brooke Lyon, Liisa L. Romero, Lucinda A. Raber, Benjamin M. Mortenson, Melinda M. Shim, Veronica C. Datrice-Hill, Nicole M. McEvoy, Jennifer R. Arasu, Vignesh A. Wisner, Dorota J. Chang, Sharon B. Ann Surg Oncol Breast Oncology BACKGROUND: Intraoperative ultrasound (IUS) localization for breast cancer is a noninvasive localization technique. In 2015, an IUS program for breast-conserving surgery (BCS) was initiated in a large, integrated health care system. This study evaluated the clinical results of IUS implementation. METHODS: The study identified breast cancer patients with BCS from 1 January to 31 October 2015 and from 1 January to 31 October 2019. Clinicopathologic characteristics were collected, and localization types were categorized. Clinical outcomes were analyzed, including localization use, surgeon adoption of IUS, day-of-surgery intervals, and re-excision rates. Multivariate logistic regression analysis was performed to evaluate predictors of re-excision. RESULTS: The number of BCS procedures increased 23%, from 1815 procedures in 2015 to 2226 procedures in 2019. The IUS rate increased from 4% of lumpectomies (n = 79) in 2015 to 28% of lumpectomies (n = 632) in 2019 (p < 0.001). Surgeons using IUS increased from 6% (5 of 88 surgeons) in 2015 to 70% (42 of 60 surgeons) in 2019. In 2019, 76% of IUS surgeons performed at least 25% of lumpectomies with IUS. The mean time from admission to incision was shorter with IUS or seed localization than with wire localization (202 min with IUS, 201 with seed localization, 262 with wire localization in 2019; p < 0.001). The IUS re-excision rates were lower than for other localization techniques (13.6%, vs 19.6% for seed localization and 24.7% for wire localization in 2019; p = 0.006), and IUS predicted lower re-excision rates in a multivariable model (odds ratio [OR], 0.59). CONCLUSIONS: In a high-volume integrated health system, IUS was adopted for BCS by a majority of surgeons. The use of IUS decreased the time from admission to incision compared with wire localization, and decreased re-excision rates compared with other localization techniques. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-021-10454-8. Springer International Publishing 2021-08-26 2021 /pmc/articles/PMC8418593/ /pubmed/34448055 http://dx.doi.org/10.1245/s10434-021-10454-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Breast Oncology Chakedis, Jeffery M. Tang, Annie Kuehner, Gillian E. Vuong, Brooke Lyon, Liisa L. Romero, Lucinda A. Raber, Benjamin M. Mortenson, Melinda M. Shim, Veronica C. Datrice-Hill, Nicole M. McEvoy, Jennifer R. Arasu, Vignesh A. Wisner, Dorota J. Chang, Sharon B. Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective |
title | Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective |
title_full | Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective |
title_fullStr | Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective |
title_full_unstemmed | Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective |
title_short | Implementation of Intraoperative Ultrasound Localization for Breast-Conserving Surgery in a Large, Integrated Health Care System is Feasible and Effective |
title_sort | implementation of intraoperative ultrasound localization for breast-conserving surgery in a large, integrated health care system is feasible and effective |
topic | Breast Oncology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418593/ https://www.ncbi.nlm.nih.gov/pubmed/34448055 http://dx.doi.org/10.1245/s10434-021-10454-8 |
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