title: Systematic cavity shaving: modifications of breast cancer management and long-term local recurrence, a multicentre study.
abstract: BACKGROUND
  The status of the surgical margins of lumpectomy is one of the most important determinants of local recurrence in breast cancer. Systematically practicing cavity margin resection is debated but may avoid surgical re-excision and allow the diagnosis of multifocality.
  
  
  METHODS
  This multicentric retrospective study included 294 patients who underwent conservative management of breast cancer with 2-4 systematic cavity shavings. Clinico-biological characteristics of the patients were collected in order to establish whether surgical management was modified by systematic cavity shaving. Local recurrence rate with a long-term follow up of minimum 4 years was evaluated.
  
  
  RESULTS
  Cavity shaving avoided the need for re-excision in 25% of cases and helped in the diagnosis of multifocality in 8% of cases. Resection volume was not associated with usefulness of the cavity shaving. No predictive factor of positive cavity shaving was found. The rate of local recurrence was 3.7% and appeared in a median time of 3 years and 8 month. Only one quarter of the patients with local recurrence had initially positive lumpectomy margins but negative cavity shaving.
  
  
  CONCLUSIONS
  Systematic cavity shaving can change surgical management of conservative treatment. No specific target population for useful cavity shaving was found, such that we recommend utilising it systematically.
authors.affiliation: Department of Surgery, Lariboisière Hospital, 2 rue Ambroise Paré, 75010 Paris, France. delphine.hequet@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Héquet
authors.forename: A
authors.initials: A
authors.lastname: Bricou
authors.forename: M
authors.initials: M
authors.lastname: Koual
authors.forename: M
authors.initials: M
authors.lastname: Ziol
authors.forename: J G
authors.initials: JG
authors.lastname: Feron
authors.forename: R
authors.initials: R
authors.lastname: Rouzier
authors.forename: J P
authors.initials: JP
authors.lastname: Brouland
authors.forename: Y
authors.initials: Y
authors.lastname: Delpech
authors.forename: E
authors.initials: E
authors.lastname: Barranger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Breast cancer; Breast conservative surgery; Cavity shaving; Local recurrence; Lumpectomy; Margin