Clinical ScienceLocalization of nonpalpable breast lesions with sonographically visible clip: optimizing tailored resection and clear margins

- Achieving clear margins is a challenge for nonpalpable breast cancers.
- Preoperative localization of a clip placed to mark the lesion depends on clip type.
- We compared 2 different types of clip localized before lumpectomy.
- A higher rate of clear margins was obtained using a sonographically visible clip.
- Localization of a sonographically visible clip allows a more tailored lumpectomy.

BackgroundAchieving clear margins with adequate resection volumes is one of the principal goals of breast-conserving surgery. The aim of our study was to compare preoperative localization using 2 different clips, radiopaque or sonographically visible, to reach this goal.MethodsWe reviewed 209 consecutive nonpalpable breast cancers that were treated with lumpectomy: 59 with radiopaque and 150 with sonographically visible clip positioned during biopsy procedure. In the former case, preoperative localization was performed with mammography and in the latter by ultrasonography.ResultsClear margins were achieved in 80.4% of patients: 57.6% in the first and 89.3% in the second group (P < .0001; odds ratio, 7.6; 95% confidence interval, 3.4 to 17.2). By using sonographically visible clips, the re-excision rate has decreased from 42.4% to 10.7%, (P < .0001), and resections resulted smaller with average calculated resection ratio of 3.54 vs 5.08 (P = .03).ConclusionsPreoperative localization using a sonographically visible clip allows a more tailored breast-conserving surgery and reduces the re-excision rate.