Abstract
Background
The multicenter randomized controlled COBALT trial demonstrated that ultrasound-guided
breast-conserving surgery (USS) results in a significant reduction of margin involvement
(3.1% vs. 13%) and excision volumes compared to palpation-guided surgery (PGS).
The aim of the present study was to determine long term oncological and patient-reported
outcomes including quality of life (QoL), together with their progress over time.
Methods
134 patients with T1–T2 breast cancer were randomized to USS (N = 65) or PGS (N = 69).
Cosmetic outcomes were assessed with the Breast Cancer Conservative Treatment cosmetic
results (BCCT.core) software, panel-evaluation and patient self-evaluation on a 4-point
Likert-scale. QoL was measured using the EORTC QLQ-C30/-BR23 questionnaire.
Results
No locoregional recurrences were reported after mean follow-up of 41 months. Seven
patients (5%) developed distant metastatic disease (USS 6.3%, PGS 4.4%, p = 0.466),
of whom six died of disease (95.5% overall survival). USS achieved better cosmetic
outcomes compared to PGS, with poor outcomes of 11% and 21% respectively, a result
mainly attributable to mastectomies due to involved margins following PGS. There was
no difference after 1 and 3 years in cosmetic outcome. Dissatisfied patients included
those with larger excision volumes, additional local therapies and worse QoL. Patients
with poor/fair cosmetic outcomes scored significantly lower on aspects of QoL, including
breast-symptoms, body image and sexual enjoyment.
Conclusion
By significantly reducing positive margin status and lowering resection volumes, USS
improves the rate of good cosmetic outcomes and increases patient-satisfaction. Considering
the large impact of cosmetic outcome on QoL, USS has great potential to improve QoL
following breast-conserving therapy.
Keywords
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Article info
Publication history
Published online: November 23, 2016
Accepted:
November 3,
2016
Identification
Copyright
© 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
