Surgeon-Performed Point-of-Care Ultrasound in Complex Breast Lesions: Implications for Oncologic Diagnosis and Surgical Planning

Surgeon-performed point-of-care breast ultrasound (POCUS) has become a practical adjunct in the evaluation and management of breast lesions, allowing real-time imaging to be incorporated directly into clinical and operative decision-making. In the oncologic setting, complex breast lesions often require timely characterization, tissue diagnosis, localization, and surgical planning, and the separation of imaging and surgical workflows may contribute to delay, fragmented care, and reduced procedural efficiency. This narrative review examines the technical principles, diagnostic applications, surgical planning utility, clinical outcomes, and implementation requirements of surgeon-performed POCUS in complex breast disease. PubMed, Scopus, and Google Scholar were searched without language restriction, and the retrieved evidence was synthesized thematically. No protocol was registered, and no formal risk-of-bias assessment or quantitative pooling was undertaken. Surgeon-performed POCUS supports immediate assessment of palpable, screening-detected, cystic, solid, and otherwise complex breast lesions using standardized sonographic descriptors and Breast Imaging Reporting and Data System (BI-RADS) interpretation. Limited prospective data indicate diagnostic validity approaching that of radiologist-performed ultrasound when the examination is undertaken by appropriately trained surgeons, although direct head-to-head comparisons remain scarce. In breast-conserving surgery (BCS), predominantly single-institution observational studies have associated intraoperative ultrasound (IOUS) guidance with improved lesion localization, lower positive margin and re-excision rates, and favorable cosmetic outcomes. The technique also facilitates same-visit interventions, including aspiration, core needle biopsy, clip placement, and preoperative localization. Successful adoption requires competency-based training, quality assurance, and institutional credentialing within multidisciplinary breast care models. By linking imaging, biopsy, localization, and operative planning within a single workflow, surgeon-performed POCUS may improve diagnostic efficiency and patient-centered outcomes, although the supporting evidence is largely observational and prospective comparative trials are lacking.