Routine cavity shaves following breast conserving surgery; friend or foe?

Monib, Sherif; Anis, Karim; Habashy, Hany

doi:10.1016/j.suronc.2021.101521

Cited by 7 publications

(4 citation statements)

References 23 publications

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“…Mohamedahmed et al, in a previous analysis, reported a longer surgical time when cavity shaving was performed (79 ± 4 min vs. 67 ± 3 min, mean difference 12.14, p = 0.002) [23]. Monib et al found that cavity shaves ensure microscopic clearance with no significant increase in operating time [24]. Despite this comparison of patients subjected to cavity shave or not, surgical times declared in these studies were comparable with time reported in our analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this comparison of patients subjected to cavity shave or not, surgical times declared in these studies were comparable with time reported in our analysis. The control group in our analysis underwent intraoperative pathological examination of resected margins that despite a longer surgical time presented a lower incidence of positive margins compared to the aforementioned methods [24].…”

Section: Discussionmentioning

confidence: 99%

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Cavity Shave Margins in Breast Conservative Surgery a Strategy to Reduce Positive Margins and Surgical Time

Vanni,

Pellicciaro,

Renelli

et al. 2024

Current Oncology

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Background: Resection of additional tissue circumferentially around the cavity left by lumpectomy (cavity shave) was suggested to reduce rates of positive margins and re-excision. Methods: A single center retrospective study which analyzed margins status, re-excision, and surgical time in patients who underwent breast conserving surgery and cavity shave or intraoperative evaluation of resection margins. Results: Between 2021 and 2023, 594 patients were enrolled in the study. In patients subjected to cavity shave, a significant reduction in positive, focally positive, or closer margins was reported 8.9% vs. 18.5% (p = 0.003). No difference was reported in terms of surgical re-excision (p < 0.846) (5% vs. 5.5%). Surgical time was lower in patients subjected to cavity shave (<0.001). The multivariate analysis intraoperative evaluation of sentinel lymph node OR 1.816 and cavity shave OR 2.909 were predictive factors for a shorter surgical time. Excluding patients subjected to intraoperative evaluation of sentinel lymph node and patients with ductal carcinoma in situ, patients that underwent the cavity shave presented a reduced surgical time (67.9 + 3.8 min vs. 81.6 + 2.8 min) (p = 0.006). Conclusions: Cavity shaving after lumpectomy reduced the rate of positive margins and it was associated with a significant reduction in surgical time compared to intraoperative evaluation of resection margins.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cavity Shave Margins in Breast Conservative Surgery a Strategy to Reduce Positive Margins and Surgical Time

Vanni,

Pellicciaro,

Renelli

et al. 2024

Current Oncology

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“…Differently, Monib et al. reported that cavity shaves, ensuring microscopic clearance, do not increase operating time ( 26 ). We reported a longer operative time in the C group; this is most likely linked to the technical time needed for the intraoperative evaluation of surgical margins.…”

Section: Discussionmentioning

confidence: 99%

Impact of cavity shave margins in patients with ductal carcinoma in situ undergoing conserving breast surgery

Vanni,

Pellicciaro,

Materazzo

et al. 2024

Front. Oncol.

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AimThe main challenge during breast-conserving surgery (BCS) is to obtain clear margins, especially in patients with ductal carcinoma in situ (DCIS) due to the absence of well-defined nodules. Many surgical approaches have been used in an attempt to reduce the positive margin rate. The aim of this retrospective study is to compare the cavity shave margin technique with standard surgery and the intraoperative evaluation of surgical margins.MethodsThis is a single-center retrospective study analyzing margin status, need for re-excision, and surgical time in a cohort of 227 patients who underwent surgery from September 2016 to September 2022.ResultsIn patients subjected to cavity shaving, we reported a significant reduction in positive margins of 17.1% versus 28.7% (p-value = 0.042). Also, a difference in terms of surgical re-excision was reported as p-value = 0.039 (12.4% versus 23.8%, respectively, for the cavity shave and control group). In the multivariate analysis, intraoperative evaluation of the margins was a risk factor for margins re-excision (Wald = 4.315, p = 0.038, OR: 2.331 [95% CI: 1.049–5.180]). Surgical time was lower in patients subjected to cavity shaves (p = 0.024), and the relative mean time was 68.4 min ± 37.1 min in the cavity shave group versus 93.9 min ± 40.6 min in the control group.ConclusionThe cavity shave margin technique in conserving breast surgery results in a reduction in positive margin rate, surgical re-excision, and operative time.

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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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Routine cavity shaves following breast conserving surgery; friend or foe?

Cited by 7 publications

References 23 publications

Cavity Shave Margins in Breast Conservative Surgery a Strategy to Reduce Positive Margins and Surgical Time

Cavity Shave Margins in Breast Conservative Surgery a Strategy to Reduce Positive Margins and Surgical Time

Impact of cavity shave margins in patients with ductal carcinoma in situ undergoing conserving breast surgery

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

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