Impact of systematic cavity shave margins in breast-conserving surgery at a large community hospital with a low baseline re-excision rate.
biopsy concordance
breast cancer
breast-conserving surgery
margin status
re-excision
systematic cavity shave margins
Journal
The breast journal
ISSN: 1524-4741
Titre abrégé: Breast J
Pays: United States
ID NLM: 9505539
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
02
04
2020
revised:
31
08
2020
accepted:
01
09
2020
pubmed:
21
10
2020
medline:
22
6
2021
entrez:
20
10
2020
Statut:
ppublish
Résumé
Systematic cavity shave margins (CSM) can decrease rate of positive margins and re-excision beyond that of selective CSM. The objective of this study was to determine whether systematic CSM decreased re-excision rate in a population with a low baseline re-excision rate. We conducted a retrospective chart review of patients who underwent breast-conserving surgery (BCS) from November 2013 to November 2017. Primary end points were re-excision rate and margin status. Secondary end points were total volume of tissue excised, operative time, and concordance of core needle biopsy (CNB) pathology with final surgical pathology. The re-excision rates were 14.29% in the no shave margin group; 15.38% in the selective CSM; and 14.59% in the systematic CSM (P = .985). Odds of re-excision with ductal carcinoma in situ (DCIS) was 5.04 times greater than with invasive cancer (INV) and 1.94 times higher than with INV and DCIS. There was no significant difference in positive margins between groups (P = .362). Mean specimen volume was lowest in the systematic CSM group (64.6 cm
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1960-1965Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Wang K, Ren Y, He J. Cavity shaving plus lumpectomy versus lumpectomy alone for patients with breast cancer undergoing breast-conserving surgery: a systematic review and meta-analysis. PLoS One. 2017;12:e0168705.
Chagpar A, Killelea B, Tsangaris T, et al. A randomized, controlled trial of cavity shave margins in breast caancer. N Engl J Med. 2015;373:503-510.
Jones V, Linebarger J, Perez S, Gabram 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.
Gray R, Pockaj B, Garvey E, Blair S. Intraoperative margin management in breast-conserving surgery: a systematic review of the literature. Ann Surg Oncol. 2018;25:18-27.
Kaczmarski K, Wang P, Gilmore R, Overton H, et al. Surgeon re-excision rates after breast conserving surgery: a measure of low-value care. J Am Coll Surg. 2019;228(4):504-512.e2.
Harris P, Taylor R, Thielke R, Payne J, et al. Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377-381.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22:276-282.
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.
Malik HZ, George WD, Mallon EA, Harnett AN, Macmillan RD, Purushotham AD. Margin assessment by cavity shaving after breast-conserving surgery: analysis and follow-up of 543 patients. Eur J Surg Oncol. 1999;25:464-469.
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.
Dupont E, Tsangaris T, Garcia-Cantu C, et al. Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery. Ann Surg. 2019.
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.
Wolf JH, Wen Y, Axelrod D, et al. Higher volume at time of breast conserving surgery reduces re-excision in DCIS. Int J Surg Oncol. 2011;2011:785803.
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.