A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer

Chagpar, Anees B.; Killelea, Brigid K.; Tsangaris, Theodore N.; Butler, Meghan; Stavris, Karen; Li, Fangyong; Yao, Xiaopan; Bossuyt, Veerle; Harigopal, Malini; Lannin, Donald R.; Lajos, Pusztai; Horowitz, Nina

doi:10.1056/nejmoa1504473

Cited by 306 publications

(220 citation statements)

References 18 publications

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“…Recently, the St Gallen panel2 recommended a minimal acceptable surgical margin of ‘no ink on invasive tumour or DCIS’. Other interventions significantly reducing intraoperative tumour margin positivity have been described: digital specimen radiology ( P = 0·012 for digital versus conventional mammography)59, tumour margin cavity shaves60 and real‐time cancer margin assessments61 62. Ataseven and colleagues22 reported that neoadjuvant chemotherapy‐induced pathological complete cancer response rates increased the surgical options for BCS without compromising clinical outcomes, an approach requiring future investigation.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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BackgroundThe clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC).MethodsComprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized.ResultsTwenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women.ConclusionThe available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.

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Section: Discussionmentioning

confidence: 99%

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Winters¹,

Horsnell

Elvers

et al. 2018

BJS Open

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“…12,14 Regarding the diameter of tumor, it was 2.2 cm in shave group and 2.3 cm in non-shave group. Tumour was ductal in 90-95% and lobular in 5-10% of both groups, with non-significant difference.…”

Section: Demographic and Clinical Patients' Data (Table)mentioning

confidence: 93%

“…12 Despite the fact that there is no agreed definition of optimal edges-tumor free margin, it is frequently stated that the sufficient edge width is 1 cm wide, with the hope that postoperative irradiation can destroy microscopic remains of disease beyond this distance. 12 The objective of this study was to evaluate the effect of routine excision of circumferential cavity shave margins versus standard partial mastectomy on outcomes after breast-conserving surgery.…”

Section: -13mentioning

confidence: 99%

“…However, others claimed that it is sufficient to excise selective margins where the tumor appears to be close to the edge of the specimen on the basis of intraoperative imaging and gross assessment. [7][8][9][10] The tumor edges differ from patient to patients and can be summarized in the following types: [11][12][13] • Positive edges: tumor cells are present at the edge In all studies, the highest local reoccurrence rate corresponds to "more than focally positive margins" and lowest local recurrences rate to "negative margin tumors".…”

Section: Introductionmentioning

confidence: 99%

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Cavity shave margins for breast conservative surgery

2017

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Background: 20-40% of patients have positive margins after partial mastectomy. Taking additional tissue circumferentially around the cavity left by partial mastectomy "cavity shave margins" may reduce the rate of positive margins. This review aims to evaluate the effect of routine excision of circumferential cavity shave margins after breast-conserving surgery.Methods: This randomized controlled trial had been conducted in General Surgery Department, Sohag Faculty of Medicine from January 2015 to April 2017. 40 patients with early breast cancer were candidates for partial mastectomy and randomly assigned in a 1:1 ratio to have either additional circumferential cavity shave margins or not.Results: The mean age of both groups were around 39 years (range 30-50 years). More than half of the cases fell in stage I, with a little more than 20% of them were in stage 0 and the rest in stage II at time of operation. Although cavity shave group had longer operative time, longer hospital stay, and higher amount of blood loss; all these showed non-significant difference between the two groups. The mean amount of resected volume was significantly higher among cavity shave group compared to non-cavity shave group. The percentage of positive margin reduced from 40% before shave to only 10% after shave margin.Conclusions: Cavity shaving resulted in significant reduction of the rates of positive margins and re-operation among patients undergoing breast-conserving surgery.

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“…BCS include lumpectomy and sentinel lymph node biopsy followed by adjuvant therapy and whole breast radiation therapy [1][2][3]. The aim of BCS is to completely excise the tumour with negative margins and maintain satisfactory and acceptable cosmetic outcome.…”

Section: Introductionmentioning

confidence: 99%

Should cavity shave margins be performed as a routine in breast conserving surgery? A review of randomised controlled trials

Clement¹

2017

Int J Surg Med

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Background:Breast-conserving surgery (BCS) is the standard of care for women with early breast cancer. The margin status is crucial in breast-conserving surgery and is an important determinant for local recurrence. Local recurrence is associated with decreased overall and disease-free survival. Several studies have shown that cavity shave margin reduces the rate of positive margins and local recurrence. This review analyses the randomised controlled trials to compare the role of cavity shave margin in breast conserving surgery and its effect on positive margins and re-excision rates. Methods: A systematic search of literature published before December 2016 for randomised controlled trials in MEDLINE, Pubmed, EMBASE, Proquest, Cochrane central register of controlled trials and Google Scholar was performed. Out of 12 articles, two randomised controlled trials were eligible. Positive margins and re-excision rates were analysed using odds ratio and risk difference. Results: Out of 12 studies, 2 were suitable for review. Overall positive margins were 18.3% and 36% in the CSM and No-CSM groups respectively, with an odds ratio of 0.373 (95% CI, 0.189 to 0.739, P = 0.232) and risk difference of -0.194 (95% CI, -0.336 to -0.053, P= 0.198). The re-excision rates were lower in the CSM group when compared to the No-CSM group (12.2% vs 31.3%) with an odds ratio of 0.28 (95% CI, 0.160 to 0.520, P=0.578) and risk difference was -0.199 (95% CI, -0.309 to -0.089, P=0.264). Conclusion: Analysis of the randomised controlled trials showed that cavity shave margins significantly reduced the risk of positive margins and the need for re-excision. It is a beneficial technique in women undergoing lumpectomy and breast conserving surgery.

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A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer

Cited by 306 publications

References 18 publications

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Systematic review of the impact of breast‐conserving surgery on cancer outcomes of multiple ipsilateral breast cancers

Cavity shave margins for breast conservative surgery

Should cavity shave margins be performed as a routine in breast conserving surgery? A review of randomised controlled trials

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