Annals of Surgical Oncology

, Volume 18, Issue 5, pp 1349–1355 | Cite as

Impact of Routine Cavity Shave Margins on Breast Cancer Re-excision Rates

  • Anne Kobbermann
  • Alison Unzeitig
  • Xian-Jin Xie
  • Jingsheng Yan
  • David Euhus
  • Yan Peng
  • Venetia Sarode
  • Amy Moldrem
  • A. Marilyn Leitch
  • Valerie Andrews
  • Carrie Stallings
  • Roshni Rao
Breast Oncology

Abstract

Purpose

Breast-conserving therapy (BCT) is an accepted method of treating early breast cancer. We hypothesized that routine excision of additional cavity shave margins (CSM) at time of initial partial mastectomy reduces the need for additional surgery.

Methods

A single-institution retrospective review was performed of women, 18 years or older, with a new diagnosis of breast cancer who underwent partial mastectomy between 1 January 2004 and 1 October 2009. Five hundred thirty-three charts were reviewed. Of those, 69 patients underwent CSM at time of initial operation. These 69 patients were matched with patients who had undergone partial mastectomy without CSM by tumor size, presence of extensive intraductal component, and primary histology.

Results

The two groups were well matched for age, nuclear grade, associated lymphovascular invasion (LVI), receptor status, and multifocality. We found that 31.9% (44/138) required return to the operating room (OR) for re-excision of margins. Rate of return to the OR was 21.7% (15/69) in the CSM group and 42.0% (29/69) in the matched group (p = 0.011). Multivariate analysis found factors significantly associated with need for additional operation included lack of CSM (odds ratio 9.2, 95% CI 2.8–30.5, p = 0.0003), larger extent of intraductal component (odds ratio 7.0, 95% CI 1.8–27.0, p = 0.005), and lack of directed re-excision (odds ratio 6.4, 95% CI 1.7–25.1, p = 0.007).

Conclusions

CSM at time of initial partial mastectomy decreases rate of re-excision by as much as ninefold. CSM should be considered at time of initial operation to reduce the need for subsequent reoperation.

References

  1. 1.
    Morrow M, White J, Moughan J, et al. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol. 2001;19:2254–62.PubMedGoogle Scholar
  2. 2.
    Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.PubMedCrossRefGoogle Scholar
  4. 4.
    Camp ER, McAuliffe PF, Gilroy JS, et al. Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg. 2005;201:855–61.PubMedCrossRefGoogle Scholar
  5. 5.
    Blair SL, Thompson K, Rococco J, Malcarne V, Beitsch PD, Ollila DW. Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons? J Am Coll Surg. 2009;209:608–13.PubMedCrossRefGoogle Scholar
  6. 6.
    Sabel MS, Rogers K, Griffith K, et al. Residual disease after re-excision lumpectomy for close margins. J Surg Oncol. 2009;99:99–103.PubMedCrossRefGoogle Scholar
  7. 7.
    Wiley EL, Diaz LK, Badve S, Morrow M. Effect of time interval on residual disease in breast cancer. Am J Surg Pathol. 2003;27:194–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Gray RJ, Salud C, Nguyen K, et al. Randomized prospective evaluation of a novel technique for biopsy or lumpectomy of nonpalpable breast lesions: radioactive seed versus wire localization. Ann Surg Oncol. 2001;8:711–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Rissanen TJ, Makarainen HP, Kiviniemi HO, Suramo, II. Ultrasonographically guided wire localization of nonpalpable breast lesions. J Ultrasound Med. 1994;13:183–8.PubMedGoogle Scholar
  10. 10.
    Rissanen TJ, Makarainen HP, Mattila SI, et al. Wire localized biopsy of breast lesions: a review of 425 cases found in screening or clinical mammography. Clin Radiol. 1993;47:14–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Gray RJ, Pockaj BA, Karstaedt PJ, Roarke MC. Radioactive seed localization of nonpalpable breast lesions is better than wire localization. Am J Surg. 2004;188:377–80.PubMedCrossRefGoogle Scholar
  12. 12.
    Thompson M, Henry-Tillman R, Margulies A, et al. Hematoma-directed ultrasound-guided (HUG) breast lumpectomy. Ann Surg Oncol. 2007;14:148–56.PubMedCrossRefGoogle Scholar
  13. 13.
    Smith LF, Henry-Tillman R, Harms S, et al. Hematoma-directed ultrasound-guided breast biopsy. Ann Surg. 2001;233:669–75.PubMedCrossRefGoogle Scholar
  14. 14.
    Kaufman CS, Jacobson L, Bachman B, Kaufman LB. Intraoperative ultrasonography guidance is accurate and efficient according to results in 100 breast cancer patients. Am J Surg. 2003;186: 378–82.PubMedCrossRefGoogle Scholar
  15. 15.
    Smith LF, Rubio IT, Henry-Tillman R, Korourian S, Klimberg VS. Intraoperative ultrasound-guided breast biopsy. Am J Surg. 2000;180:419–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Rahusen FD, Bremers AJ, Fabry HF, van Amerongen AH, Boom RP, Meijer S. Ultrasound-guided lumpectomy of nonpalpable breast cancer versus wire-guided resection: a randomized clinical trial. Ann Surg Oncol. 2002;9:994–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Ngo C, Pollet AG, Laperrelee J, Ackerman G, Gomme S, Thibault F, Fourchotte V, Salmon RJ. Intraoperative ultrasound localization of nonpalpable breast cancers. Ann Surg Oncol. 2007;14:2485–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Jakub JW, Gray RJ, Degnim AC, Boughey JC, Gardner M, Cox CE. Current status of radioactive seed for localization of non palpable breast lesions. Am J Surg. 2010 April;199(4):522–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Rao R, Moldrem A, Sarode V, et al. Experience with seed localization for nonpalpable breast lesions in a public health care system. Ann Surg Oncol. 2010. doi:10.1245/s10434-010-1139-4.
  20. 20.
    Lavoue V, Nos C, Clough KB, et al. Simplified technique of radioguided occult lesion localization (ROLL) plus sentinel lymph node biopsy (SNOLL) in breast carcinoma. Ann Surg Oncol. 2008;15:2556–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Monti S, Galimberti V, Trifiro G, et al. Occult breast lesion localization plus sentinel node biopsy (SNOLL): experience with 959 patients at the European Institute of Oncology. Ann Surg Oncol. 2007;14:2928–31.PubMedCrossRefGoogle Scholar
  22. 22.
    Intra M, de Cicco C, Gentilini O, Luini A, Paganelli G. Radioguided localisation (ROLL) of non-palpable breast lesions and simultaneous sentinel lymph node biopsy (SNOLL): the experience of the European Institute of Oncology. Eur J Nucl Med Mol Imaging. 2007;34:957–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Young ES, Hogg DE, Krontiras H, et al. Specimen radiographs assist in identifying and assessing resection margins of occult breast carcinomas. Breast J. 2009;15:521–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Mazouni C, Rouzier R, Balleyguier C, et al. Specimen radiography as predictor of resection margin status in non-palpable breast lesions. Clin Radiol. 2006;61:789–96.PubMedCrossRefGoogle Scholar
  25. 25.
    Cabioglu N, Hunt KK, Sahin AA, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol. 2007;14:1458–71.PubMedCrossRefGoogle Scholar
  26. 26.
    Ramanujam N, Brown J, Bydlon TM, et al. Quantitative spectral reflectance imaging device for intraoperative breast tumor margin assessment. Conf Proc IEEE Eng Med Biol Soc. 2009;1:6554–6.Google Scholar
  27. 27.
    Gibson GR, Lesnikoski BA, Yoo J, Mott LA, Cady B, Barth RJ, Jr. A comparison of ink-directed and traditional whole-cavity re-excision for breast lumpectomy specimens with positive margins. Ann Surg Oncol. 2001;8:693–704.PubMedCrossRefGoogle Scholar
  28. 28.
    Jacobson AF, Asad J, Boolbol SK, Osborne MP, Boachie-Adjei K, Feldman SM. Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision? Am J Surg. 2008;196:556–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Hewes JC, Imkampe A, Haji A, Bates T. importance of routine cavity sampling in breast conservation surgery. Br J Surg. 2009;96:47–53.PubMedCrossRefGoogle Scholar
  30. 30.
    Tengher-Barna I, Hequet D, Reboul-Marty J, et al. Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast lumpectomy. Mod Pathol. 2009;22:299–305.PubMedCrossRefGoogle Scholar
  31. 31.
    Janes SE, Stankhe M, Singh S, Isgar B. Systematic cavity shaves reduces close margins and re-excision rates in breast conserving surgery. Breast. 2006;15:326–30.PubMedCrossRefGoogle Scholar
  32. 32.
    Marudanayagam R, Singhal R, Tanchel B, O’Connor B, Balasubramanian B, Paterson I. Effect of cavity shaving on reoperation rate following breast-conserving surgery. Breast J. 2008;14:570–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383–93.PubMedCrossRefGoogle Scholar
  34. 34.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–106.Google Scholar
  35. 35.
    Fisher B, Bauer M, Margolese R 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. NEJM. 1985;312:665–73.PubMedCrossRefGoogle Scholar
  36. 36.
    Lester SC, Bose S, Yunn-Yi C, et al. Protocol for the examination of specimens from patients with invasive carcinoma of the breast. Arch Pathol Lab Med. 2009 Oct;133(10):1515–38.PubMedGoogle Scholar
  37. 37.
    Molina MA, Snell S, Franceschi D et al. Breast specimen orientation. Ann Surg Oncol. 2009;16:285–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Cao D, Lin C, Woo S, Vang R, Tsangaris TN, Argani P. Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol. 2005;29:1625–32.PubMedCrossRefGoogle Scholar
  39. 39.
    Rizzo M, Iyengar R, Gabram SGA, Park J, Birdsong G, Chandler KL, Mosunjac MB. The effects of additional tumor cavity sampling at the time of breast-conserving surgery on final margin status, volume of resection, and pathologist workload. Ann Surg Oncol. 2010;17:228–34.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Anne Kobbermann
    • 1
  • Alison Unzeitig
    • 1
  • Xian-Jin Xie
    • 2
  • Jingsheng Yan
    • 2
  • David Euhus
    • 1
  • Yan Peng
    • 3
  • Venetia Sarode
    • 3
  • Amy Moldrem
    • 1
  • A. Marilyn Leitch
    • 1
  • Valerie Andrews
    • 1
  • Carrie Stallings
    • 1
  • Roshni Rao
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Clinical SciencesUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of PathologyUniversity of Texas Southwestern Medical CenterDallasUSA

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