Standardizing Tissue Preservation in Breast‐Conserving Surgery: Ultrasound Guidance Reduces Resection Volumes by 40% Compared to Palpation

ABSTRACT Background Ultrasound guidance (US) may optimize breast‐conserving surgery (BCS) by standardizing resection precision, but comparative quantitative data remain limited. This study evaluates whether US improves margin control and tissue preservation versus palpation‐guided BCS using a calculated resection ratio (CRR). Methods Retrospective analysis of 114 patients with BCS (37 palpation‐guided; 77 US‐guided [34 palpable and 43 nonpalpable]). Primary endpoints: positive margin rates, re‐excision rates, and CRR. Statistical analysis included Mann–Whitney U tests (CRR) and multivariate logistic regression. Results US guidance reduced positive margins by 76% (2.2% vs. 9.0% and p < 0.0001) and re‐excisions by 81% (2.6% vs. 14.0%). Resection efficiency improved by 40% (median CRR 1.8 vs. 3.0 and p < 0.001), with nonpalpable tumors achieving the lowest CRR (1.6). For a representative 2 cm tumor, US guidance reduced total resection volumes by 78% (17.6 vs. 81.4 cm 3 ) and healthy tissue excision by 81% (14.6 vs. 78.4 cm 3 ) compared to palpation‐guided surgery. Multivariate analysis showed nonsignificant trends for the US (OR 0.375 and p = 0.416), though clinical benefits were consistent across subgroups. However, CRR correlated with cosmetic outcomes (91% vs. 78% “Excellent/Good”), suggesting dual oncologic‐esthetic benefits. Conclusions US‐guided BCS standardizes tissue preservation, reducing resection volumes by 40% while maintaining oncologic safety. CRR emerges as a replicable metric for surgical quality. Despite nonsignificant multivariate results, the magnitude of improvement supports US adoption where expertise exists.