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Circumferential Shaving of the Cavity in Breast-Conserving Surgery: A Randomized Controlled Trial

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

Abstract

Background

This randomized controlled trial aimed to investigate the effects of circumferential shaving on reducing the intraoperative margin positivity rate (MPR) during breast-conserving surgery (BCS).

Methods

Eligible breast cancer patients were randomly assigned into no-shave and shave groups. In the no-shave group, the cavity margins were collected for assessment after the tumor resection, whereas in the shave group, a circumferential shaving was performed before collecting the cavity margins. The primary outcome was the intraoperative MPR by frozen section analysis.

Results

A total of 181 patients, with a median age of 49 years, were randomized. Patient characteristics at baseline were well-balanced between the two groups. The intraoperative MPRs (12.1% vs. 7.8%, p = 0.38), postoperative MPRs (16.5% vs. 7.8%, p = 0.073), intraoperative re-excision rates (26.4% vs. 23.3%, p = 0.64), second operation rates (4.4% vs. 1.1%, p = 0.34), and successful BCS rate (93.4% vs. 94.4%, p = 0.94) were all similar between the no-shave and the shave groups. The volume of the shaved tissues was significantly increased in patients with larger breast volume (p < 0.01). In patients with C–E cup breasts, the no-shave and shave groups had 16.7% and 0% (p = 0.03) intraoperative MPRs, and 22.0% and 0% (p = 0.01) postoperative MPRs, respectively. In patients with A–B cup breasts, the MPRs were similar between the two groups. The presence of the ductal carcinoma in situ component is the only determinant of margin positivity.

Conclusions

Circumferential shaving did not significantly reduce the MPR in BCS. Its benefit depends on the volume of the shaved tissues and the breast.

Trial registration This trial was registered at ClinicalTrials.gov (NCT02648802).

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Acknowledgment

This work was supported by grants from the National Key Research and Development Program of China (2016YFC1302300), the Natural Science Foundation of China (81720108029), Guangdong Science and Technology Department (2016B030229004), and Guangzhou Science Technology and Innovation Commission (201803040015), and was also supported by the Yat-sen Scholarship of Young Scientist of Sun Yat-sen Memorial Hospital, and partly supported by Fountain-Valley Life Sciences Fund of University of Chinese Academy of Sciences Education Foundation.

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Author notes

  1. Kai Chen, Liling Zhu, and Lili Chen have contributed equally to this work.

Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Kai Chen MD, Liling Zhu MD, Lili Chen MSN, Qian Li BSN, Shunrong Li MD, Na Qiu AST, Yaping Yang MD, Fengxi Su MD & Erwei Song MD, PhD

  2. Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China

    Kai Chen MD, Liling Zhu MD, Lili Chen MSN, Qian Li BSN, Shunrong Li MD, Na Qiu AST, Yaping Yang MD, Fengxi Su MD & Erwei Song MD, PhD

  3. Fountain-Valley Institute for Life Sciences, Guangzhou Institute of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China

    Erwei Song MD, PhD

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  1. Kai Chen MD
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10434_2019_7725_MOESM1_ESM.tiff

Box-plots showing the volume of the shaved tissues in patients with (a) different breast volume, and (b) different breast density (TIFF 1174 kb)

Supplementary material 2 (DOC 29 kb)

Supplementary material 3 (DOC 94 kb)

Supplementary material 4 (DOC 181 kb)

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Chen, K., Zhu, L., Chen, L. et al. Circumferential Shaving of the Cavity in Breast-Conserving Surgery: A Randomized Controlled Trial. Ann Surg Oncol 26, 4256–4263 (2019). https://doi.org/10.1245/s10434-019-07725-w

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