534 Use of Ultrasound by Breast Surgeons Reduces the Need for Wire-Guided Localisation Of Impalpable Breast Tumours By Radiologists

Aim Ultrasound is increasingly being used by non-radiologists in clinical practice. Currently wire-guided localisation (WGL) of impalpable breast tumours requires the expertise of radiologists but can be uncomfortable and demands significant radiology resource. Furthermore, for logistical reasons at our institution during the COVID pandemic, wires were inserted the day before surgery, resulting in disruption to patients. At our institution, two of eight breast surgeons use ultrasound intraoperatively for localisation of breast lesions, thus obviating the need for a radiologist to localise the lesion for the surgeon. We hypothesise that ultrasound-localisation by surgeons is an effective way to improve patient experience. Method We undertook a retrospective review of all patients undergoing wire-guided localisation of impalpable breast tumours between 01/05/20-01/08/20. We retrospectively collected the following data: modality of image-guided insertion (ultrasound versus x-ray), operating surgeon and size of tumour. Results 48 tumours were excised using WGL. 45 of these relied on ultrasound guidance for insertion. The median lesion size was 17mm, with 30 (62.5%) of lumps being ³10mm in size. Conclusions Most impalpable lumps were visualised using ultrasound. The majority of these lumps were >10mm. Surgeons trained in ultrasound did not need localisation by radiologists. If breast surgeons were unanimously trained to use ultrasound for intra-operative localisation, a significant proportion of wires could be avoided, saving cost, radiology time, patient time and improving the patient experience. We argue that ultrasound should be a core part of breast trainees’ curriculum.