Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial COBALTReport as inadecuate




Intraoperative Ultrasound Guidance in Breast-Conserving Surgery Improves Cosmetic Outcomes and Patient Satisfaction: Results of a Multicenter Randomized Controlled Trial COBALT - Download this document for free, or read online. Document in PDF available to download.

Annals of Surgical Oncology

, Volume 23, Issue 1, pp 30–37

First Online: 20 October 2015Received: 25 June 2015DOI: 10.1245-s10434-015-4906-4

Cite this article as: Haloua, M.H., Volders, J.H., Krekel, N.M.A. et al. Ann Surg Oncol 2016 23: 30. doi:10.1245-s10434-015-4906-4

Abstract

BackgroundUltrasound-guided breast-conserving surgery USS results in a significant reduction in both margin involvement and excision volumes COBALT trial.

ObjectiveThe 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.

MethodsA 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.

ResultsUltrasound-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 ptrend = 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.

ConclusionUltrasound-guided breast-conserving surgery achieved better overall cosmetic outcomes and patient satisfaction than PGS. Lumpectomy volumes >40 cc resulted in significantly worse cosmetic outcomes.

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Author: Max H. Haloua - José H. Volders - Nicole M. A. Krekel - Alexander M. F. Lopes Cardozo - Wifred K. de Roos - Louise 

Source: https://link.springer.com/



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