Systematic cavity shaves reduces close margins and re-excision rates in breast conserving surgery.

The role of cavity shaves in reducing re-excision rates in breast conserving surgery (BCS) remains unclear. We compared rates of close margins and re-excision following cavity shaves based on either intraoperative radiology or systematic cavity shaves. Data was recorded prospectively from 1999 to 2003 for 217 patients undergoing BCS. For the first 106 cases, cavity shaves were performed when intraoperative radiological margins appeared close (<10 mm). The remaining 111 cases had systematic superior and inferior cavity shaves (SSICS). Close margins and re-excision rates were compared between groups. The median weight of excised tissue was less in group two: 82.8 g versus 100.5 g, P=0.001. SSICS reduced close margins by 83% (18/106 versus 8/111), OR 0.17, 95% CI 0.08-0.48, P=0.001. Multivariate analysis showed SSICS also reduced re-excision rates (15 versus 8 cases), OR 0.26, 95% CI 0.09-0.74, P=0.012. SSICS reduces close margins and re-excision rates. This approach has additional cosmetic benefits because less tissue is excised.

[1]  S. Noguchi,et al.  Malignant Seeding of the Lumpectomy Cavity upon Breast-Conserving Surgery , 1999, Oncology.

[2]  S. Steele,et al.  Secondary operations are frequently required to complete the surgical phase of therapy in the era of breast conservation and sentinel lymph node biopsy. , 2004, American journal of surgery.

[3]  J. Hendriks,et al.  Histologic multifocality of tis, T1–2 breast carcinomas implications for clinical trials of breast‐conserving surgery , 1985, Cancer.

[4]  U. Veronesi How important is the assessment of resection margins in conservative surgery for breast cancer? , 1994, Cancer.

[5]  S. Jeffrey,et al.  Predictors of reexcision findings and recurrence after breast conservation. , 2003, International journal of radiation oncology, biology, physics.

[6]  A. Luini,et al.  Conservative treatment of early breast cancer. Long-term results of 1232 cases treated with quadrantectomy, axillary dissection, and radiotherapy. , 1990, Annals of surgery.

[7]  E. Mallon,et al.  Tumour bed positivity predicts outcome after breast‐conserving surgery , 1997, The British journal of surgery.

[8]  R. Rainsbury,et al.  Detection of residual disease following breast‐conserving surgery , 1998, The British journal of surgery.

[9]  B Fisher,et al.  Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. , 1985, The New England journal of medicine.

[10]  S. Singletary Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. , 2002, American journal of surgery.

[11]  A. Purushotham,et al.  Margin assessment by cavity shaving after breast-conserving surgery: analysis and follow-up of 543 patients. , 1999, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[12]  K. Moorthy,et al.  Is the reexcision rate higher if breast conservation surgery is performed by surgical trainees? , 2004, American journal of surgery.

[13]  A. O'Doherty,et al.  Intraoperative margin assessment and re-excision rate in breast conserving surgery. , 2004, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[14]  F. Vicini,et al.  Factors associated with local recurrence of mammographically detected ductal carcinoma in situ in patients given breast‐conserving therapy , 2000, Cancer.

[15]  B Fisher,et al.  Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. , 1989, The New England journal of medicine.

[16]  B. Cady,et al.  A Comparison of Ink-Directed and Traditional Whole-Cavity Re-Excision for Breast Lumpectomy Specimens With Positive Margins , 2001, Annals of Surgical Oncology.

[17]  L. Barthelmes,et al.  Effect of cavity margin shavings to ensure completeness of excision on local recurrence rates following breast conserving surgery. , 2003, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.