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Additional Cavity Shaving at the Time of Breast-Conserving Surgery Enhances Accuracy of Margin Status Examination

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

We addressed the impact of separate cavity margin excision (shaving) during breast-conserving surgery (BCS) for breast cancer on specimen volume, tumor margin clearance, re-excision rate, local recurrence and survival.

Methods

A retrospective case-matched study was performed on 298 women with stage 0–III breast cancer; 179 patients received shaving (shaving + lumpectomy group; SLG) and 119 patients did not (lumpectomy group; LG).

Results

The two groups had similar baseline characteristics. The median volume of surgical specimen was 131.9 cc in the SLG versus 134.8 cc in the LG (p = 0.81), and surgical margins were tumor-free in 90.7 % of cases in the LG versus 92.7 % in the SLG (87.1 % before shaving) (p = 0.69). The re-excision rate was 14.3 % in the LG versus 10.6 % in the SLG (p = 0.44). In the SLG, shaving spared 10 (5.6 %) patients from reoperation (positive lumpectomy margins but tumor-free shaving margins) (p = 0.11), and only 2/19 (10.5 %) patients in the SLG had tumor-free response at histological examination of re-excised margins compared with 10/17 (58.8 %) cases in the LG (p = 0.004). Tumor in shavings was found in 44/156 (28.2 %) patients having tumor-free lumpectomy margins. At multivariate analysis, distance of tumor from lumpectomy margins, tumor multifocality, receptor status, and tumor size were related to tumor persistence in shavings. Median follow-up was 27 months (range 23–35), and two patients had tumor relapse in the SLG versus none in the LG (p = 0.16). Overall survival was 100 % in both groups.

Conclusions

Shaving does not significantly decrease the re-excision rate but provides wider clear margins in most procedures. It ensures more accurate margin examination and decreases false-positive margin rate, without any increase in removed breast-tissue volume.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy

    Giacomo Pata MD, Anna Bianchi MD, Mario Pasini MD, Stefano Roncali MD & Fulvio Ragni MD

  2. Department of Medical and Surgical Sciences, 2nd Division of General Surgery, University of Brescia School of Medicine, Brescia, Italy

    Michele Bartoli MD

Authors
  1. Giacomo Pata MD
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  2. Michele Bartoli MD
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  3. Anna Bianchi MD
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  4. Mario Pasini MD
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  5. Stefano Roncali MD
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  6. Fulvio Ragni MD
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Correspondence to Giacomo Pata MD.

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Pata, G., Bartoli, M., Bianchi, A. et al. Additional Cavity Shaving at the Time of Breast-Conserving Surgery Enhances Accuracy of Margin Status Examination. Ann Surg Oncol 23, 2802–2808 (2016). https://doi.org/10.1245/s10434-016-5210-7

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  • DOI: https://doi.org/10.1245/s10434-016-5210-7

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