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

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

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.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Anne Kobbermann MD, Alison Unzeitig BS, David Euhus MD, Amy Moldrem MD, A. Marilyn Leitch MD, Valerie Andrews MD, Carrie Stallings MD & Roshni Rao MD

  2. Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Xian-Jin Xie PhD & Jingsheng Yan PhD

  3. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Yan Peng PhD & Venetia Sarode MD

Authors
  1. Anne Kobbermann MD
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  2. Alison Unzeitig BS
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  3. Xian-Jin Xie PhD
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  4. Jingsheng Yan PhD
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  5. David Euhus MD
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  6. Yan Peng PhD
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  7. Venetia Sarode MD
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  8. Amy Moldrem MD
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  9. A. Marilyn Leitch MD
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Correspondence to Roshni Rao MD.

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Kobbermann, A., Unzeitig, A., Xie, XJ. et al. Impact of Routine Cavity Shave Margins on Breast Cancer Re-excision Rates. Ann Surg Oncol 18, 1349–1355 (2011). https://doi.org/10.1245/s10434-010-1420-6

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  • DOI: https://doi.org/10.1245/s10434-010-1420-6

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