Do we need to routinely perform cavity shaving with breast-conserving surgery for breast cancer? A systematic review and meta-analysis

Mohamedahmed, Ali Yasen Y.; Zaman, Shafquat; Srinivasan, Ananth; Peterknecht, Elizabeth; Mohammed, Salma Saeed S.; Albendary, Mohamed; Alnzaer, Alsmwal Alnour; Elsamani, Kareemaldin

doi:10.1016/j.suronc.2020.11.003

Cited by 8 publications

(6 citation statements)

References 47 publications

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“…A different result was reported by Mohamedahmed et al. ( 25 ). In their analysis, the authors reported a longer surgical time when cavity shaving is performed (79 min ± 4 min vs. 67 min ± 3 min; mean difference: 12.14; p = 0.002) ( 25 ).…”

Section: Discussioncontrasting

confidence: 63%

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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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Section: Discussioncontrasting

confidence: 63%

“…( 25 ). In their analysis, the authors reported a longer surgical time when cavity shaving is performed (79 min ± 4 min vs. 67 min ± 3 min; mean difference: 12.14; p = 0.002) ( 25 ). In the analysis by Mohamedahmed et al., the control group was not subjected to intraoperative evaluation of resection 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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“…In our study, patients had a lower reoperation rate due to positive margins (5.4%), when compared to the rates of BCS, whose values vary from 20% to 30% ( 7 , 31 , 32 ). This might be explained by two main factors: the use of OP and the role of MRI in preoperative planning.…”

Section: Discussionmentioning

confidence: 39%

Prospective study: Impact of breast magnetic resonance imaging on oncoplastic surgery and on indications of mastectomy in patients who were previously candidates to breast conserving surgery

et al. 2023

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BackgroundRoutine use of magnetic resonance imaging (MRI) in the staging of patients with early breast cancer is still controversial. Oncoplastic surgery (OP) allows for wider resections without compromising the aesthetic results. This study aimed to assess the impact of preoperative MRI on surgical planning and on indications of mastectomy.MethodsProspective study including T1-T2 breast cancer patients treated between January 2019 and December 2020 in the Breast Unit of the Hospital Nossa Senhora das Graças in Curitiba, Brazil. All patients had indication for breast conserving surgery (BCS) with OP and did a breast MRI after conventional imaging.Results131 patients were selected. Indication for BCS was based on clinical examination and conventional imaging (mammography and ultrasound) findings. After undergoing breast MRI, 110 patients (84.0%) underwent BCS with OP and 21 (16.0%) had their surgical procedure changed to mastectomy. Breast MRI revealed additional findings in 52 of 131 patients (38%). Of these additional findings, 47 (90.4%) were confirmed as invasive carcinoma. Of the 21 patients who underwent mastectomies, the mean tumor size was 2.9 cm (± 1,7cm), with all having additional findings on breast MRI (100% of the mastectomies group vs 28.2% of the OP, p<0.01). Of the 110 patients submitted to OP, the mean tumor size was 1,6cm (± 0,8cm), with only 6 (5.4%) presenting positive margins at the final pathology assessment.ConclusionPreoperative breast MRI has an impact on the OP scenario, bringing additional information that may help surgical planning. It allowed selecting the group with additional tumor foci or greater extension to convert to mastectomy, with a consequent low reoperation rate of 5.4% in the BCS group. This is the first study to assess the impact of breast MRI in the preoperative planning of patients undergoing OP for the treatment of breast cancer.

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“…Multiple radioactive seed is another means for tumor localization with good result of negative resection margin [14]. After resection of the tumor, evaluation of the specimen using MarginProbe® resulted in signi cantly decreased positive resection margin [15] and routine tumor cavity shaving is also known to be effective to reduce the positive margin and re-excision rate [16][17][18]. The way we used to get the FM specimen was also a kind of tumor cavity shaving and that might have affected the result of PM as previously mentioned.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Frozen Section Margin Positive in Breast-Conserving Surgery; Current Status and Ways to Reduce It.

LEE

Yoo

et al. 2023

Preprint

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Purpose There have been many analyzes of permanent resection margin (PM) in breast conserving surgery (BCS) but few studies have organized the data of intraoperative frozen section margin (FM). We were aimed to focus more on FM and organize the data including FM. Methods A single center, retrospective study was conducted. The electronic medical records of the patients who underwent BCS for breast cancer between January 2015 and December 2015 in Asan Medical Center were reviewed. We investigated the rate of positive FM and the difference in operation time according to the result of FM. Also, we analyzed various patient and tumor related factors which can affect the result of resection margin (RM) including FM. Results 1,110 patients were included in the analysis. FM evaluation was done in 56.5% (627/1110). The rate of positive FM was 12.4% (78/627). The operation time was significantly longer when additional resection was done for positive FM (112.7 ± 32.6 min vs 74.7 ± 22.9 min, p < .001). By univariate analysis, multiplicity, non-mass enhancement (NME) on magnetic resonance imaging (MRI), maximum diameter on MRI, T3, N2-3, invasive lobular carcinoma (ILC), presence of extensive intraductal component (EIC) and presence of ductal carcinoma in situ (DCIS) were factors significantly associated with the result of RM while after multivariate analysis, multiplicity, ILC and presence of EIC showed statistical significance. Conclusions The operation time was significantly longer when additional resection was done for positive FM. Further data collection and organization is needed for standardized predictive tool for FM.

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Do we need to routinely perform cavity shaving with breast-conserving surgery for breast cancer? A systematic review and meta-analysis

Cited by 8 publications

References 47 publications

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

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

Prospective study: Impact of breast magnetic resonance imaging on oncoplastic surgery and on indications of mastectomy in patients who were previously candidates to breast conserving surgery

Intraoperative Frozen Section Margin Positive in Breast-Conserving Surgery; Current Status and Ways to Reduce It.

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