Randomized trial evaluating intraoperative ultrasound guidance for palpable breast cancer excision

Evaluation of: Krekel NM, Halou MH, Lopes Cardozo AM et al. Intraoperative ultrasound guidance for palpable breast cancer excision (COBALT trial): a multicentre, randomised controlled trial. Lancet Oncol. 14(1), 48-54 (2013). Breast-conserving surgery with lumpectomy and adjuvant radiation is the treatment of choice for the majority of early-stage breast cancers. The goals of surgery are to remove the tumor with adequate margins while maintaining an excellent cosmetic outcome. Multiple factors have been associated with higher local recurrence rates, including positive surgical margins. For most nonpalpable breast cancers, needle localization is considered the gold standard for tumor localization when performing lumpectomies. By contrast, palpable breast cancers have historically been excised to grossly negative margins based on palpation alone, which may lead to higher positive margin rates. As a result, ultrasound has been proposed as a tool for intraoperative guidance in the surgical excision of palpable masses. The trial under discussion is a randomized study demonstrating that the use of ultrasound intraoperatively to guide breast conservation surgery decreases the rate of positive margins and the volume of excised tissue, potentially allowing for a better cosmetic outcome.