Role of image diagnosis in breast conserving surgery. Simulation of surgery using helical CT

The role of image diagnosis in breast conserving surgery (BCS) was evaluated with special reference to simulation of surgery using helical computed tomography (CT). One-hundred-thirty patients who underwent BCS were studied and the rate of positive surgical margin was assessed. Patients were divided into two groups: 96 cases who underwent simulation of surgery using CT and 34 cases without CT evaluation. With CT evaluation, 69 cases out of 96 were supposed to be eligible for BCS and 27 cases were found to have extending lesions. The rate of positive surgical margin was 20.6% in cases without CT evaluation, 10.1% in eligible cases and 18.5% in cases with extending lesions. CT evaluation achieved reduction of positive surgical margin by approximately 50% in eligible cases. In cases with extending lesions, CT revealed minimal involvement which could not be detected by physical examination or mammography and CT-guided surgery was possibly performed individually. These results indicate that CT is a useful breast imaging to depict minimal involvement and to determine the required type of surgery or the extent of resection. (author)