title: Clinical outcomes of breast-conserving surgery in patients using a modified method for cavity margin assessment.
abstract: BACKGROUND
  This study describes a modified intraoperative method for cavity margin (CM) assessment in place of lumpectomy margin assessment in patients undergoing breast-conserving surgery (BCS).
  
  
  METHODS
  This is a retrospective review of 422 breast cancer patients undergoing BCS with intraoperative CM assessment. After an initial lumpectomy with intent to obtain ≥1-cm margins, separate specimens 1 × 1 cm, 0.5-cm thick were taken from the cavity margin circumferentially. These were frozen without reference to the side of the new margin as a time-saving measure, and parallel sections of the resected surface were evaluated.
  
  
  RESULTS
  After a median follow-up of 55.5 months, a cumulative 5-year locoregional recurrence-free survival rate of 95.3%, metastasis-free survival rate of 97.8%, disease-free survival rate of 88.3%, and overall survival rate of 96.0%, was achieved. The CM positivity rates were of no statistical difference when <7, 7-8, and >8 CMs were assessed. The second operation rate was 3.5% because of the false-negative results of the frozen section analysis on CMs. Univariate and multivariate analysis revealed that a higher pN stage and cT stage as well as a lack of adjuvant chemotherapy or radiation demonstrated significantly worse clinical outcomes. Locoregional recurrences and metastasis are both correlated with worse overall survival. The number of the CMs assessed was not associated with clinical outcomes.
  
  
  CONCLUSIONS
  The modified CM assessment presented here is a rapid, accurate, and oncologically safe approach for margin evaluation in BCS patients. Lumpectomy margin assessment might be spared when this method is used.
authors.affiliation: Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Kai
authors.initials: K
authors.lastname: Chen
authors.forename: Yunjie
authors.initials: Y
authors.lastname: Zeng
authors.forename: Haixia
authors.initials: H
authors.lastname: Jia
authors.forename: WeiJuan
authors.initials: W
authors.lastname: Jia
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.forename: Nanyan
authors.initials: N
authors.lastname: Rao
authors.forename: Erwei
authors.initials: E
authors.lastname: Song
authors.forename: Charles E
authors.initials: CE
authors.lastname: Cox
authors.forename: Fengxi
authors.initials: F
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002277:Carcinoma / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005188:False Negative Reactions; D005260:Female; D005629:Frozen Sections; D006801:Humans; D053208:Kaplan-Meier Estimate; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult