Effect of Cavity Shaving on Reoperation Rate Following Breast-Conserving Surgery

Abstract

Breast-conserving surgery (BCS) without adequate margin clearance carries a high risk of local recurrence. We introduced cavity shaving at primary surgery 31 months ago, to assess tumor margin involvement. The aim of this study was to determine how cavity shaving affects the re-excision rate. We compared a group of 394 patients who underwent BCS with cavity shaving of macroscopically clear margins at primary operation, from March 2003 to September 2005 with a group of 392 patients who underwent BCS only from January 2000 to February 2003. Cavity shaves and re-excision specimens were measured and oriented with reference to the primary cancer. Pathological results of all the specimens were analyzed and re-excision rates in both groups were recorded. Compared with BCS alone where 49 of 392 patients (12.5%) required reoperation for margin clearance, only 22 of 394 patients (5.58%) of the group who had concurrent cavity shaves required further surgery (p < 0.01). Analysis of re-excised specimens suggests that reoperation could have been avoided in 44 of 49 patients, if they had standard sized cavity shave at primary operation. We conclude that cavity shavings during primary BCS significantly reduce the re-excision rate to ensure microscopic clearance.

Cavity shave margins for breast conservative surgery

“…Cao et al, found that 59% of103 patients who had positive margins on their initial specimen had negative margins after cavity shaving. 18,19 Tengher-Barna et al Similarly, found that 42% of 47 patients who had positive marginson their initial specimen had negative margins with cavity shaving. Jacobson et al 20,21 found that routine cavity shaving eliminated the need for a second surgery for margin clearance in 49% of 125 patients.…”

Should cavity shave margins be performed as a routine in breast conserving surgery? A review of randomised controlled trials

“…The aim of BCS is to completely excise the tumour with negative margins and maintain satisfactory and acceptable cosmetic outcome. The importance of margin status of breast conserving surgery for breast cancer is well documented [3][4][5][6][7][8]. Although the overall survival rates for breast conversing surgery is equivalent to total mastectomy, margin status is an important determinant of local recurrence.…”

“…Although the overall survival rates for breast conversing surgery is equivalent to total mastectomy, margin status is an important determinant of local recurrence. It has been reported that approximately 20-40% of patients have positive margins after breast conserving surgery and require re-excision for clear margins [3,[6][7][8]. Negative margin does not mean a complete absence of residual unresected tumour in the treated breast, but it results in decreased tumour burden low enough to be treated with radiotherapy.…”

“…Negative margin does not mean a complete absence of residual unresected tumour in the treated breast, but it results in decreased tumour burden low enough to be treated with radiotherapy. Positive margins are associated with 2 to 3 times increased the risk of local recurrence [7][8][9][10][11].…”

“…It is reported that the local recurrence is associated with decreased overall and disease-free survival [6,7,11,12]. The determination of negative margins on a lumpectomy specimen depends on the adequacy of excision and the method of margin assessment.…”