Redefining Margin Assessment in Breast Conservation Surgery: Surgeon-Performed Intraoperative Ultrasound as a Reliable Alternative to Radiologic and Mammographic Assessment

Objective: Accurate intraoperative margin assessment during breast-conserving surgery (BCS) is essential to minimize re-excision and preserve cosmesis. In resource-constrained settings, advanced imaging and frozen section analysis are often unavailable, and surgeons frequently rely on visual-tactile judgment. This study compared the diagnostic accuracy of surgeon-performed intraoperative specimen ultrasound (IOSpUS-S), radiologist-performed specimen ultrasound (IOSpUS-R), specimen mammography, and gross inspection against final histopathology. Materials and Methods: This prospective study included 40 patients with early breast cancer undergoing wide local excision at a tertiary centre in central India. Each excised specimen was evaluated intraoperatively, ex vivo, by gross inspection, IOSpUS (surgeon and radiologist), and specimen mammography. Diagnostic parameters, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and correlation with the final histopathological margins, were calculated. Receiver operating characteristic analysis was performed to determine discriminative performance. Results: <0.001). Only one patient (2.5%) had a close margin that was correctly identified by both IOSpUS modalities and mammography, but was missed on gross inspection. Conclusion: Surgeon-performed IOSpUS provides real-time, workflow-efficient intraoperative margin assessment, with diagnostic performance comparable to that of radiologist-performed ultrasound and specimen mammography in this prospective cohort. In low-resource environments, gross examination, though less sensitive, remains a viable adjunct when imaging facilities are limited. A combined approach has the potential to reduce re-excision by supporting intraoperative decision-making.