M P Van Den Tol
VU University medical center Amsterdam, Netherlands
M P Van Den Tol has completed her surgical training in 2002 and her training for oncological surgeon in 2004. She completed her Ph.D at the Erasmus University Rotterdam, The Netherlands in 2001. From 2004 till now she is working as a oncological surgeon and researcher at the VU Medical Center, Amsterdam, The Netherlands. She here provides clinical care for cancer patients, which she combines with training PhD candidates in research projects on surgical oncology and imaging. She has published more than 50 papers in reputed journals.
Introduction: Breast-conserving surgery for palpable breast cancer is worldwide associated with a high rate of tumour-involved margins and excessive healthy tissue resection. In this perspective a randomised controlled trial was initiated to compare USS with the standard palpation-guided surgery (PGS) for palpable breast cancer. Materials and methods: A total of 134 eligible patients with palpable T1-T2 invasive breast cancer were randomised to either USS (n=65) or PGS (n=69). Outcome measures included resection margin status, re-excision rates, mastectomy rates and additional radiotherapy. Secondary outcome measures were operative time, complications, cosmetic outcome and cost-benefit. Results: In the USS-group, 3.1% of margins were involved, compared with 17.4% in the PGS-group (P=0.009). The use of intra-operative US resulted in a significant reduction in additional therapies (P=0.015). Excision volumes were reduced with USS (38cc vs. 58cc P<0.002). Analysis of cosmetic self-evaluation after 3 months showed better nipple position in the USS-group compared to the PGS-group (P=0.016). Furthermore, 3 months after surgery, patients in the USS were more satisfied with the appearance of their breasts than in the PGS group (P=0.015). Mean extra costs per patient due to margin involvement in the PGS-group were 446€ compared with 169€ in the USS-group. Yearly costs of a US-system are 8,286€. Therefore, USS for palpable breast cancer can save a breast unit 277€ per patient after the first 30 operated patients (on a yearly basis). A breast unit operating 200 patients per year can achieve 47.090€ of cost savings. Conclusion: USS can prevent the unacceptably high rate of tumour-involved resection margins and reduce the excision volumes in palpable breast cancer excision, thus not only improving oncological and cosmetic outcomes but also considerably reducing treatment costs.