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From the Department of Surgery (FDR), Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands; Departments of Surgical Oncology (AJAB, HFJF, SM) and Radiology (AHMTvA), Vrije Universiteit Medical Center, Amsterdam, The Netherlands; and Department of Surgery (RPAB), District General Hospital, Amstelveen, The Netherlands.
Correspondence: Address correspondence and reprint requests to: S. Meijer, MD, PhD, VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam; Fax: 31-2-4444512; E-mail: s.meijer{at}vumc.nl
Background: The wire-guided excision of nonpalpable breast cancer often results in tumor resections with inadequate margins. This prospective, randomized trial was undertaken to investigate whether intraoperative ultrasound (US) guidance enables a better margin clearance than the wire-guided technique in the breast-conserving treatment of nonpalpable breast cancers.
Methods: Patients with a preoperative histological diagnosis of nonpalpable breast cancer that could be visualized both with US and mammography were included. Patients were randomized to undergo either a wire-guided or a US-guided excision. Adequate margins were defined as 
1 mm.
Results: Of 49 included patients, 23 were assigned to undergo wire-guided excision and 26 to undergo US-guided excision. One patient crossed over to US-guided excision after inadvertent wire displacement. Mean tumor diameter, specimen weight, and operating time were similar in both groups. The excision was adequate in 24 (89%) of 27 US-guided excisions and 12 (55%) of 22 wire-guide excisions (P = .007).
Conclusions: US-guided excision seems to be superior to wire-guided excision with respect to margin clearance of mammographically detected and US-visible nonpalpable breast cancers. Patients do not have to undergo the unpleasant wire placement before surgery.
Key Words: Nonpalpable • Mammography • Ultrasonography • Breast neoplasms • Segmental mastectomy • Needle biopsy
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