Advertisement

Annals of Surgical Oncology

, Volume 18, Issue 1, pp 114–118 | Cite as

Surgical Management Modifications Following Systematic Additional Shaving of Cavity Margins in Breast-Conservation Treatment

  • Delphine Héquet
  • Alexandre Bricou
  • Yann Delpech
  • Emmanuel Barranger
Breast Oncology

Abstract

Background

Positive wide local excision margins are the most important risk factor of local breast-carcinoma recurrence. Shaving additional margins could lower the need for re-excisions when wide local excision margins are positive and cavity margins are negative.

Materials and Methods

This retrospective study, from January 2007 to December 2008, included 99 women with breast carcinomas who underwent wide local excision with 4 additional, systematically shaved, surgical cavity margins. All therapeutic decisions concerning post-wide local excision treatment were made by consensus during multidisciplinary meetings.

Results

This systematic cavity-shaving strategy avoided 25 re-excisions (25.3%), and 6 patients required new surgery because of carcinoma found in the additional cavity-shaving margins, despite negative wide local excision margins. No preoperative factor predictive of positive cavity margins was identified.

Conclusions

Systematic shaving of additional cavity margins changed the surgical management after breast-conservation treatment.

Keywords

Invasive Lobular Carcinoma Estrogen Receptor Status Wide Local Excision Progesterone Receptor Status Additional Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, wide local excision, and wide local excision plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.CrossRefPubMedGoogle Scholar
  2. 2.
    Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRefPubMedGoogle Scholar
  3. 3.
    Schnitt SJ. Risk factors for local recurrence in patients with invasive breast cancer and negative surgical margins of excision: where are we and where are we going? Am J Clin Pathol. 2003;120:485–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Schnitt SJ. Morphologic risk factors for local recurrence in patients with invasive breast cancer treated with conservative surgery and radiation therapy. Breast J. 1997;3:261–6.CrossRefGoogle Scholar
  5. 5.
    Gage I, Schnitt S, Nixon A, Silver B, Recht A, Troyan SL, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78:1921–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Macmillan RD, Purushotam AD, Mallon E, Ramsay G, George WD. Breast-conserving surgery and tumour bed positivity in patients with breast cancer. Br J Surg. 1994;81:56–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Kurtz JM. Factors influencing the risk of local recurrences in the breast. Eur J Cancer. 1992;28:660–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Keskek M, Kothari M, Ardehali B, Betambeau N, Nasiri N, Gui GP. Factors predisposing to cavity margin positivity following conservation surgery for breast cancer. Eur J Surg Oncol. 2004;30:1058–64.CrossRefPubMedGoogle Scholar
  9. 9.
    Taghian A, Mohiuddin M, Jagsi R, Jagsi R, Goldberg S, Ceilley E, et al. Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005;241:629–39.CrossRefPubMedGoogle Scholar
  10. 10.
    Pittinger TP, Maronian NC, Poulter CA, Peacock JL. Importance of margin status in outcome of breast-conserving surgery for carcinoma. Surgery. 1994;116:605–8.PubMedGoogle Scholar
  11. 11.
    Cao D, Lin C, Woo SH, Vang R, Tsangaris TN, Argani P. Separate cavity margin sampling at the time of initial breast wide local excision significantly reduces the need for reexcisions. Am J Surg Pathol. 2005;29:1625–32.CrossRefPubMedGoogle Scholar
  12. 12.
    Huston TL, Piglarga R, Osborne MP, Tousimis E. The influence of additional surgical margins on the total specimen volume excised and the preoperative rate after breast-conserving surgery. Am J Surg. 2006;192:509–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Tengher-Barna I, Héquet D, Reboul-Marty J, Frassati-Biaggi A, Seince N, Rodrigues-Faure A, et al. Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast wide local excision. Mod Pathol. 2009;22:299–305.CrossRefPubMedGoogle Scholar
  14. 14.
    Barthelmes L, Al Awa A, Crawford DJ. Effect of cavity margin shaving to ensure completeness of excision on local recurrence rates following breast conserving surgery. Eur J Surg Oncol. 2003;29:644–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Malik HZ, Wilkinson L, George WD, Purushotham AD. Preoperative mammographic features predict clinicopathological risk factors for the development of local recurrence in breast cancer. Breast. 2000;94:1383–90.Google Scholar
  16. 16.
    Marudanayagam R, Singhal R, Tanchel B, O’Connor B, Balasubramanian B, Paterson I. Effect of cavity shaving on reoperation rate following breast-conserving surgery. Breast J. 2008;14:570–3.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Delphine Héquet
    • 1
  • Alexandre Bricou
    • 1
  • Yann Delpech
    • 1
  • Emmanuel Barranger
    • 1
  1. 1.Obstetrics and Gynecology DepartmentLariboisière Hospital, Assitance Publique–Hôpitaux de ParisParisFrance

Personalised recommendations