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Excising Additional Margins at Initial Breast-Conserving Surgery (BCS) Reduces the Need for Re-excision in a Predominantly African American Population: A Report of a Randomized Prospective Study in a Public Hospital

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Margin status is an important prognostic factor for local recurrence after breast conserving surgery (BCS) for breast cancer. We designed a prospective randomized trial to evaluate the effect of shave margins on positive margins and locoregional recurrence (LRR).

Methods

Patients were randomized to BCS or BCS with resection of 5 additional margins (BCS + M). Tumor margins were classified as negative [>2 mm for ductal carcinoma in situ (DCIS); >1 mm for invasive carcinoma] based on guidelines at the time of accrual.

Results

A total of 75 patients with stage 0–III breast cancer (76 samples) were randomized, mean age 59.6 years with median follow-up 39.5 months. Overall, 21 patients (27.6 %) had positive margins: 14 had undergone BCS and 7 BCS + M (p = 0.005). Of the 21 patients with positive margins, 19 had DCIS on final pathology (OR 7.56; 95 % CI 1.52–37.51).All patients with positive margins were offered re-excision; 11 had negative final margins after re-excision surgery. Overall, 6 patients (8.3 %) developed LRR with recurrence being more common in the BCS group when compared with the BCS + M group (17.2 vs 2.3 %; p = 0.025).

Conclusions

Taking additional cavity shave margins at the time of initial excision resulted in a reduction in positive margin rate, a decrease in return to operating room for re-excision, and lower LRR.

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Authors and Affiliations

  1. Grady Memorial Hospital, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Veronica Jones MD, Sheryl Gabram MD, MBA & Monica Rizzo MD

  2. Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Veronica Jones MD, Sebastian Perez MPH & Sheryl Gabram MD, MBA

  3. Department of Surgery, Gundersen Health System, La Crosse, WI, USA

    Jared Linebarger MD

  4. Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA

    Joel Okoli MD

  5. Department of Surgery, Michigan State University, Lansing, MI, USA

    Harvey Bumpers MD

  6. Department of Pathology, Grady Memorial Hospital, Emory University, Atlanta, GA, USA

    Brian Burns & Marina Mosunjac MD

Authors
  1. Veronica Jones MD
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  2. Jared Linebarger MD
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  4. Sheryl Gabram MD, MBA
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  8. Marina Mosunjac MD
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  9. Monica Rizzo MD
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Correspondence to Veronica Jones MD.

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Jones, V., Linebarger, J., Perez, S. et al. Excising Additional Margins at Initial Breast-Conserving Surgery (BCS) Reduces the Need for Re-excision in a Predominantly African American Population: A Report of a Randomized Prospective Study in a Public Hospital. Ann Surg Oncol 23, 456–464 (2016). https://doi.org/10.1245/s10434-015-4789-4

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  • DOI: https://doi.org/10.1245/s10434-015-4789-4

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