Introduction:
Wire-guided localization (WGL) is a common technique for non-palpable breast cancer surgeries. However, alternatives like radio-guided surgery (RGL) and intra-operative ultrasound (IOUS) have emerged to address the drawbacks of WGL. While RGL’s effectiveness has been previously analyzed, this article focuses on a systematic review and meta-analysis specifically examining IOUS against WGL for non-palpable breast cancers.
Methods:
This review included studies evaluating surgeon-performed IOUS in treating non-palpable breast cancers and ductal carcinoma in situ (DCIS), focusing on surgical margin excision status. Randomized controlled trials (RCTs) and cohort studies comparing IOUS to WGL were selected for meta-analysis. Pooled odds ratios (ORs) and confidence intervals (CIs) were calculated using fixed-effects and random-effects models to compare the two techniques.
Results:
Eighteen studies on IOUS involving 1,328 patients with non-palpable breast cancer and DCIS were analyzed. From these, ten studies (nine cohort and one RCT) with WGL control groups were included in the meta-analysis. Localization success rates were consistently high (95-100%) across all IOUS studies. Crucially, the analysis revealed a statistically significant reduction in involved surgical margins with IOUS compared to WGL, with a pooled OR of 0.52 (95% CI 0.38-0.71).
Conclusion:
Intraoperative ultrasound (IOUS) demonstrates a clear advantage over wire-guided localization (WGL) by significantly reducing the rate of involved surgical margins in non-palpable breast cancer surgery. While these findings are promising, further validation through adequately powered randomized controlled trials is recommended to solidify the evidence and establish IOUS as a potentially superior surgical alternative to wire-guided localization.
