Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery: A Prospective Multicenter Randomized Controlled Trial.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 05 2021
01 05 2021
Historique:
pubmed:
11
7
2019
medline:
25
5
2021
entrez:
11
7
2019
Statut:
ppublish
Résumé
Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings. In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0-III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM ("shave" group) or not ("no shave" group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates. Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the "shave" group and 200 to the "no shave" group. Median patient age was 65 years (range; 29-94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the "shave" and "no shave" groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the "shave" group were significantly less likely than those in the "no shave" group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001). Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM.
Identifiants
pubmed: 31290763
pii: 00000658-202105000-00009
doi: 10.1097/SLA.0000000000003449
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
876-881Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
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; 347:1233–1241.
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; 347:1227–1232.
Houssami N, Macaskill P, Marinovich ML, et al. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 2014; 21:717–730.
Chagpar AB, Killelea BK, Tsangaris TN, et al. A randomized, controlled trial of cavity shave margins in breast cancer. N Engl J Med 2015; 373:503–510.
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 2016; 23:456–464.
Chagpar AB, Trial I. Cavity shave margins in breast cancer. N Engl J Med 2015; 373:2187–2188.
Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol 2014; 21:704–716.
Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol 2016; 23:3801–3810.
Corsi F, Sorrentino L, Bonzini M, et al. Cavity shaving reduces involved margins and reinterventions without increasing costs in breast-conserving surgery: a propensity score-matched study. Ann Surg Oncol 2017; 24:1516–1524.
Marudanayagam R, Singhal R, Tanchel B, et al. Effect of cavity shaving on reoperation rate following breast-conserving surgery. Breast J 2008; 14:570–573.
Unzeitig A, Kobbermann A, Xie XJ, et al. Influence of surgical technique on mastectomy and reexcision rates in breast-conserving therapy for cancer. Int J Surg Oncol 2012; 2012:725121.
Rizzo M, Iyengar R, Gabram SG, et al. 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; 17:228–234.
Kobbermann A, Unzeitig A, Xie XJ, et al. Impact of routine cavity shave margins on breast cancer re-excision rates. Ann Surg Oncol 2011; 18:1349–1355.
Mook J, Klein R, Kobbermann A, et al. Volume of excision and cosmesis with routine cavity shave margins technique. Ann Surg Oncol 2012; 19:886–891.
Moo TA, Choi L, Culpepper C, et al. Impact of margin assessment method on positive margin rate and total volume excised. Ann Surg Oncol 2014; 21:86–92.
Pajak C, Pao J, Ghuman A, et al. Routine shave margins are not necessary in early stage breast cancer treated with Breast Conserving Surgery. Am J Surg 2018; 215:922–925.
Gray RJ, Pockaj BA, Garvey E, et al. Intraoperative margin management in breast-conserving surgery: a systematic review of the literature. Ann Surg Oncol 2018; 25:18–27.
Huston TL, Pigalarga R, Osborne MP, et al. The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery. Am J Surg 2006; 192:509–512.
Tang R, Coopey SB, Specht MC, et al. Lumpectomy specimen margins are not reliable in predicting residual disease in breast conserving surgery. Am J Surg 2015; 210:93–98.
Hequet D, Bricou A, Koual M, et al. Systematic cavity shaving: modifications of breast cancer management and long-term local recurrence, a multicentre study. Eur J Surg Oncol 2013; 39:899–905.