Assessing the margins of the excised specimen with ultrasound during the operation itself gives results comparable to specimen mammography in breast-conserving surgery for non-palpable lesions. That is the conclusion of an analysis of 137 lesions operated on at a tertiary centre between 2018 and 2022, which compares both techniques against final histological margin status.
What was known
In breast-conserving surgery, the surgeon needs to know whether the tumour has been removed with an adequate margin before closing the wound. The usual tool for that check is specimen mammography, performed in radiology after the tissue has been excised. Intraoperative specimen ultrasound has been proposed as a faster and cheaper alternative, but its accuracy compared with mammography had not been well established in lesions that cannot be felt.
What this study adds
Retrospective analysis of prospective data from a single tertiary centre, covering January 2018 to December 2022. It included patients undergoing wide local excision for invasive breast cancer or mass-forming ductal carcinoma in situ; all operations were performed by the same senior surgeon, who also carried out the specimen ultrasound. A radiological margin was considered clear when the distance from the tumour edge was greater than 10 mm and close when it was 10 mm or less, and an additional cavity shave was performed when a close margin was identified. The analysis included 137 lesions in 132 patients, with a median age of 66 years (range 33-86); 67.5% were screen-detected, 92% were invasive tumours, and median size on preoperative imaging was 15 mm (range 5-18).
Main results
A total of 548 radial margins were assessed, of which 22 (4%) were positive on histology. Ultrasound classified 517 margins as clear and 31 as close; mammography classified 513 and 35. Sensitivity was 68.2% versus 72.7% (p = 0.61) and specificity 96.9% versus 96.4% (p = 1.0). Negative predictive value was 98.6% and 98.8% respectively.
What it means
The two techniques behave similarly. Their strength is ruling out margin involvement, with specificity and negative predictive value above 96% and 98%; their limitation is sensitivity, around 70%, so some close margins later confirmed by histology go unnoticed on radiological assessment. The study is retrospective, from a single centre and with a single surgeon, which limits how far the results can be generalised. The authors conclude that specimen ultrasound is a rapid and accessible alternative, particularly where specimen radiography is unavailable or resources limited.
Reading from the breast unit
In a breast unit it allows the margin to be assessed without waiting for the sample to be transferred to radiology, which can shorten turnaround times and support the decision to shave the cavity during the same operation. It does not replace the definitive histopathology report.
Reference: Mensah A, Rajan S, Senathirajah L, Al-Nsour A, Nunny I, Ames V, et al. Intraoperative specimen ultrasonography for margin assessment in breast conserving surgery in comparison with specimen mammography. Surgery in Practice and Science, 2026. https://doi.org/10.1016/j.sipas.2026.100363
