Standardizing Tissue Preservation in Breast-Conserving Surgery: Ultrasound Guidance Reduces Resection Volumes by 40% Compared to Palpation.

Background: Ultrasound guidance (US) may optimize breast-conserving surgery (BCS) by standardizing resection precision, but comparative quantitative data remain limited. This study evaluates whether US improves margin control and tissue preservation versus palpation-guided BCS using a calculated resection ratio (CRR).

Methods: Retrospective analysis of 114 patients with BCS (37 palpation-guided; 77 US-guided [34 palpable and 43 nonpalpable]).

Primary endpoints: positive margin rates, re-excision rates, and CRR. Statistical analysis included Mann-Whitney U tests (CRR) and multivariate logistic regression.

Results: US guidance reduced positive margins by 76% (2.2% vs. 9.0% and p < 0.0001) and re-excisions by 81% (2.6% vs. 14.0%). Resection efficiency improved by 40% (median CRR 1.8 vs. 3.0 and p < 0.001), with nonpalpable tumors achieving the lowest CRR (1.6). For a representative 2 cm tumor, US guidance reduced total resection volumes by 78% (17.6 vs. 81.4 cm³) and healthy tissue excision by 81% (14.6 vs. 78.4 cm³) compared to palpation-guided surgery. Multivariate analysis showed nonsignificant trends for the US (OR 0.375 and p = 0.416), though clinical benefits were consistent across subgroups. However, CRR correlated with cosmetic outcomes (91% vs. 78% "Excellent/Good"), suggesting dual oncologic-esthetic benefits.

Conclusions: US-guided BCS standardizes tissue preservation, reducing resection volumes by 40% while maintaining oncologic safety. CRR emerges as a replicable metric for surgical quality. Despite nonsignificant multivariate results, the magnitude of improvement supports US adoption where expertise exists.