Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision?

Jacobson, Allyson F.; Asad, Juhi; Boolbol, Susan K.; Osborne, Michael P.; Boachie‐Adjei, Kwadwo; Feldman, Sheldon

doi:10.1016/j.amjsurg.2008.06.007

Cited by 66 publications

(40 citation statements)

References 10 publications

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“…A recent RCT concluded that a significant reduction in the rate of positive margins and re-excision was demonstrated by PM patients with cavity shaving, bringing level I evidence to cavity shaving after years of persistent debate and changing the surgical management of PM treatment [6–8]. However, our study demonstrated that cavity shaving should not be routinely conducted in highly selected Chinese breast cancer patients due to the low rate of positive margins after an initial PM.…”

Section: Discussionmentioning

confidence: 73%

Low rate of positive margins and re-excision after partial mastectomy in highly selected breast cancer patients: A Chinese single-institution experience

Zhu

Yang

et al. 2017

Oncotarget

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A recent randomized controlled trial firstly demonstrated that cavity shaving significantly decreased the rate of positive margins and re-excision among partial mastectomy (PM) patients. However, it remains unknown whether cavity shaving should be routinely applied to Chinese breast cancer patients undergoing PM. A total of 408 PM patients undergoing 410 PMs among 1796 surgically treated breast cancer patients at Fudan University Shanghai Cancer Centre from January 2015 to June 2015 were included in our study. Data were analysed with univariate or multivariate analysis. Overall, 11 of 410 cases (2.7%) had positive margins postoperatively. Moreover, only 24.6% of the cases (P<0.05) presented with ductal carcinoma in situ (DCIS), among whom 10.0% obtained positive margins. In multivariate logistic regression analysis, presence of mammographic calcifications was significantly associated with margin positivity (P<0.05, OR=6.06, 95% CI: 1.53-23.91). In conclusion, cavity shaving during PM should not be routinely performed in Chinese breast cancer patients, particularly in highly selected cases with a low prevalence of DCIS. PM patients with preoperative mammographic calcifications were more likely to have positive margins and might benefit more from cavity shaving.

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Section: Discussionmentioning

confidence: 73%

Low rate of positive margins and re-excision after partial mastectomy in highly selected breast cancer patients: A Chinese single-institution experience

Zhu

Yang

et al. 2017

Oncotarget

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“…By identifying factors that are predictive of positive margins, it is hoped that surgeons may be able to alter surgical planning for those select patients who present with some or many such predictors. The surgeon performing lumpectomy on select patients with higher preoperative risk may choose to perform a wider excision at lumpectomy, utilize intraoperative touch prep, or perform additional shave margins to reduce the risk for re-excision [21]. In addition, a patient with a demonstrated higher risk who is hesitant about the option of lumpectomy may choose to undergo traditional mastectomy rather than risk the possibility of a positive margin.…”

Section: Discussionmentioning

confidence: 96%

Preoperative and intraoperative predictors of positive margins after breast-conserving surgery: a retrospective review

2011

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“…Other studies report positive CS rates of 17.4 -50.2% [14,[18][19][20][23][24][25] . CS positivity has been shown to be associated with younger age, tumour type, size and grade, extensive intraductal component, multifocality and axillary node status [14,19,20,23] .…”

Section: Discussionmentioning

confidence: 99%

Surgical judgement in assessing the need for cavity shaves during breast conserving surgery

Clark¹,

Smith²

2013

JST

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Background: The majority of patients with breast cancer in the UK undergo breast conserving surgery (BCS). Breast Conserving Surgery followed by post-operative Radiotherapy has the same 10 year survival rates as mastectomy but a higher incidence of local recurrence. One of the factors associated with local recurrence is tumour cell presence at the specimen resection margin. In order to avoid this some surgeons take extra pieces of tissue from the cavity walls after removal of the main specimen which are known as cavity shaves (CS). However, there is no consensus on adequate radial margin size or the use of cavity shaves. In this study we have analysed the outcomes of patients undergoing Breast Conserving Surgery and the use of cavity shaves in our unit. Methods:All patients who underwent BCS at our unit over a three year period were included in the study. Data collected from the Pathology report included specimen weight, tumour size, presence of tumour at radial margins and whether cavity shaves had been taken. An assessment was then made on whether the cavity shave correlating to the site of tumour at the radial margin had been taken correctly. The patients' outcome in terms of further surgery was also assessed.Results: 323 cases were included in the analysis and of these 138 had one or more CS taken at time of BCS. 88 of these 138 had clear radial margins and 50 had involved radial margins. Surgeons correctly removed the corresponding CS to involved margin in 44.5% of cases.Conclusions: Breast surgeons are poor at using intra-operative specimen X-rays or palpation of the specimen in assessing whether tumour is present at the radial margin of a breast excision specimen during breast conserving surgery. The use of cavity shaves leads to unnecessary excision of breast tissue.

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Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision?

Cited by 66 publications

References 10 publications

Low rate of positive margins and re-excision after partial mastectomy in highly selected breast cancer patients: A Chinese single-institution experience

Low rate of positive margins and re-excision after partial mastectomy in highly selected breast cancer patients: A Chinese single-institution experience

Preoperative and intraoperative predictors of positive margins after breast-conserving surgery: a retrospective review

Surgical judgement in assessing the need for cavity shaves during breast conserving surgery

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