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The COBALT trial is a small randomized multicenter trial (134 patients) for unicentric palpable breast cancers conducted in the Netherlands primarily to demonstrate the superiority of intraoperative ultrasound (US)-guided breastconservation surgery (BCS) in terms of both cosmesis and patient satisfaction. Indeed, the cosmesis was better for the image-guided surgery than for the palpation-guided surgery, as judged by a three-member panel, a computer program, and self-evaluation (odds ratio, 0.55; p = 0.067). This was primarily due to less volume of excision with US-guided BCS, less reexcision due to positive margins, and improved patient satisfaction. This ultimately led to lower cost, although this datum is not presented in the report. Likewise, Rubio et al. demonstrated utility in the neoadjuvant setting using a US– Visible marker placed at the original biopsy.

Intraoperative Image-Guided Breast-Conservation Surgery Should be the Gold Standard