Intraoperative Ultrasound vs Wire Localization in Surgery for Ductal Carcinoma in Situ

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Using intraoperative ultrasound to guide surgery for patients with ductal carcinoma in situ may yield better results than the standard technique of using a wire inserted into the breast, according to a new study published by Esgueva et al in the European Journal of Cancer. The findings were also presented at the 13th European Breast Cancer Conference (Abstract 7).


Intraoperative ultrasound enables surgeons to remove a smaller quantity of breast tissue while still removing all the of ductal carcinoma in situ tissue. Using this technique may improve the chance of having positive margins and reduce the risk of patients needing a second operation. Because an intraoperative ultrasound negates the need for inserting a guide wire, this technique could also reduce pain and preoperative stress for patients and save time for medical staff.

“[Ductal carcinoma in situ] is a common form of early breast cancer that can develop into a more serious, invasive cancer. To ensure it does not progress, patients are usually offered surgery. Because [ductal carcinoma in situ] does not usually create lumps in the breast, we need a good technique to guide surgery and make it [as] accurate as possible,” said first study author Antonio J. Esgueva, MD, a breast surgical oncologist in the Breast Cancer Unit of the University of Navarra Clinic in Pamplona, Spain.

Methodology and Results

The study researchers identified 108 patients who were diagnosed with ductal carcinoma in situ and treated from February 2018 to December 2021. Among the 108 patients, 41 were treated with intraoperative ultrasound–guided surgery, and 67 were treated with surgery guided by wire localization.

Following each operation, the removed tissue was analyzed to see how much was removed and whether there were positive margins. Among those treated using wire localization, 10.4% (n = 7) of the patients had positive margins and needed a second operation, while among those treated using an intraoperative ultrasound, only 4.8% (n = 2) of patients had positive margins and needed a second operation.

The patients underwent follow-up for 1.5 years. Only one cancer recurrence was reported in the total study population—in a patient treated with wire localization.

Study Implications

“As breast surgeons, we want to perform the very best oncological surgery in terms of removing any trace of [ductal carcinoma in situ] but also removing as little of the breast tissue as possible in order to have the best cosmetic result…. At the same time, we also want to improve patients’ experience during treatment by using less invasive techniques and reducing their anxiety. Our research suggests that using intraoperative ultrasound, a quicker and less invasive technique, is effective for guiding [ductal carcinoma in situ] surgery,” said Dr. Esgueva.

The researchers plan to continue gathering information about patients having surgery for ductal carcinoma in situ in the hopes of seeing long-term benefits of using intraoperative ultrasound.

“Once intervention is planned, the standard treatment for patients diagnosed with [ductal carcinoma in situ] is surgery. The need for a second operation due to positive margins can be an issue. This research is promising because it shows that a kinder technique can help guide surgeons to effectively remove [ductal carcinoma in situ] from the breast while minimizing unwanted side effects,” emphasized Laura Biganzoli, MD, Director of the Breast Center in the Department of Oncology at the Hospital of Prato and Co-Chair of the European Breast Cancer Conference, who was not involved in the study.

Disclosure: For full disclosures of the study authors, visit

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