Breast-Conserving Surgeries With and Without Cavity Shave Margins Have Different Re-excision Rates and Associated Overall Cost: Institutional and Patient-Driven Decisions for Its Utilization

Cartagena, Lorraine Colón; McGuire, Kandace P.; Zot, Patricija; Pillappa, Raghavendra; Idowu, Michael O.; Robila, Valentina

doi:10.1016/j.clbc.2021.03.003

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…Thus, the total number of cases with OMFBC uncovered after cavity shaving was 6 (14.3%). Our data agree with previous study, which demonstrated that cavity shaving reduces the rate of positive margins by more than 50% compared to standard partial mastectomy, with all positive margins in the cavity shave group showing criteria of multifocal cancer (16) . Another comparative study was carried out on 139 breast cancer patients who were treated with partial mastectomy and additional cavity shaving.…”

Section: Discussionsupporting

confidence: 93%

“…However, the efficacy of CS might be challenged by missing OMFBC in the shaved margins of the residual lumpectomy cavity (12) . This could occur even in patients who had negative margins of their resected tumor specimens leading to failure of BCS (15,16) . For instance, OMFBC was confirmed in CS margins of 8-23% of patients who initially had negative margins of lumpectomy (resected tumor) specimens (12,17,18) .…”

Section: Introductionmentioning

confidence: 99%

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Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Ali¹,

Gomaa²,

El‐Badry³

2021

The Egyptian Journal of Hospital Medicine

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Ali¹,

Gomaa²,

El‐Badry³

2021

The Egyptian Journal of Hospital Medicine

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“…Several strategies have been used to reduce the margins infiltration rates, including cavity shave margins, where the [15,16]. Imprint cytology is another pathological method to assess margins intraoperatively with a 80-100% sensitivity and 85-100% specificity, but it can not differentiate between in-situ and invasive component [17].…”

Section: Discussionmentioning

confidence: 99%

“…Several strategies have been used to reduce the margins infiltration rates, including cavity shave margins, where the lumpectomy cavity margins are excised in addition to tumor. Though this reduces the re‐excision rate by nearly two‐thirds, the extra tissue removal can potentially impair the cosmetic outcome [15, 16]. Imprint cytology is another pathological method to assess margins intraoperatively with a 80‐ 100% sensitivity and 85‐ 100% specificity, but it can not differentiate between in‐situ and invasive component [17].…”

Section: Discussionmentioning

confidence: 99%

Cost‐Efficacy Analysis of Use of Frozen Section Histology for Margin Assessment During Breast Conservation Surgery in Breast Cancer Patients

et al. 2023

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Background Margin assessment is an essential component of breast conservation surgery (BCS). Re-excision of infiltrated margin(s) detected on paraffin section histology (PSH) needs reoperation, adding time, inconvenience and cost. Intra-operative assessment of margins using frozen section histology (IFSH) can potentially obviate need for reoperation, thus facilitating one-step oncologically complete BCS. Methods IFSH and PSH reports of consecutive patients undergoing BCS (2010-2020) were reviewed. Accuracy and cost-efficacy of IFSH were assessed, considering PSH as gold standard. Cost of achieving oncologically complete BCS in whole cohort with IFSH (Scenario-A) was calculated and compared using appropriate statistical tests, with hospital costs for the cohort in a hypothetical Scenario-B, where IFSH was presumed not to have been used and all patients with infiltrated margin(s) on PSH would have been re-operated. Results Of the 367 patients screened, 39 were excluded due to incomplete IFSH data. Of 328 patients analyzed, 59 (18%) had one or more margins were reported infiltrated on IFSH, managed by re-excision or mastectomy in the same sitting, thus avoiding a reoperation. Additional 8 (2.4%) had involved margins on PSH (False negative IFSH). Significantly higher number of reoperations (p \ 0.001) would have been needed in scenario-B. Average cost of the first operation with use of IFSH was Indian Rupees (INR) 25791 which included INR660 as IFSH cost. The average cost of reoperation was INR23724 which could be avoided in 59 (18%) by use of IFSH. The average cost per patient to achieve oncologically complete surgery in scenario A utilizing IFSH was significantly lower (p = 0.001) by INR3101 (11.7%), c.w. that in scenario B. Significant cost-saving with IFSH was maintained in cost-efficacy analysis undertaken with various higher and lower costs assumptions. Conclusions Use of IFSH facilitates one-step oncologically complete BCS in majority of patients and results in considerable cost saving, resulting in avoidance of reoperations, besides preventing patient anxiety and delay in adjuvant treatment. Trial Registration Clinical Trials Registry-India (CTRI/2021/08/035896).

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“…Another typical intraoperative approach to reduce reinterventions after BCS is the frozen-section analysis of lumpectomy margins [29], as well as of cavity shaving margins around lumpectomy [30] (Table 3). Routine circumferential cavity shaving ensures microscopic clearance, reduces the reintervention rate, and offers superior surgical outcomes without any impact on operating time or patient satisfaction [31][32][33][34][35]. For what concerns the extemporary specimen processing for invasive breast cancer, the analysis of shaving margins seems to be adequate to exclude ink on the tumor.…”

Section: Photoacoustic Imagingmentioning

confidence: 99%

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

Bertozzi¹,

Londero²,

Nanez³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Objective: Breast-conserving surgery (BCS) experienced a significant surge during the last decades due to the increase of early breast cancer detection. Central to the discussion is margin adequacy which represents one of the most significant predictive factors for local relapse. This paper aims to shed light on the problem of margins in breast surgery. Mechanism: We performed a systematic narrative review of the literature by conducting a search using Medline/PubMed, Scopus, and Embase. The following keywords were considered: "breast-conserving surgery" AND "margins"/"margin". Findings in Brief: In the case of invasive breast cancer, "no ink on tumor" can be considered an adequate margin, while for ductal carcinoma in situ (DCIS), a distance of 2 mm from tumor should be obtained. Many novel tools have been developed based both on the latest radiological imaging techniques and on the tissue expression of certain markers, with the aim of precise navigation of tumor excision and intraoperative evaluation of cavity excision margins. Oncoplastic surgery can be considered oncologically safe while improving the cosmetic outcome and patients' quality of life. The appropriate use of adjuvant treatments in the context of a multidisciplinary and personalized management of breast cancer is the only means to omit a second intervention in some carefully selected cases. Conclusions: Debate still exists concerning the definition of adequate clear margin following BCS for DCIS. Further studies are required to better assess multimodal treatment approaches in this condition.

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Breast-Conserving Surgeries With and Without Cavity Shave Margins Have Different Re-excision Rates and Associated Overall Cost: Institutional and Patient-Driven Decisions for Its Utilization

Cited by 10 publications

References 34 publications

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Routine Margin Shaving Of Lumpectomy Cavity During Breast Conserving Surgery Detects Occult Multifocal Cancer, A Prospective Study

Cost‐Efficacy Analysis of Use of Frozen Section Histology for Margin Assessment During Breast Conservation Surgery in Breast Cancer Patients

Updates and Debate Concerning Margin Adequacy and Management following Breast-Conserving Surgery

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