title: 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.
abstract: BACKGROUND
  Margin status is an important prognostic factor for local recurrence after breast conserving surgery (BCS) for breast cancer. We designed a prospective randomized trial to evaluate the effect of shave margins on positive margins and locoregional recurrence (LRR).
  
  
  METHODS
  Patients were randomized to BCS or BCS with resection of 5 additional margins (BCS + M). Tumor margins were classified as negative [>2 mm for ductal carcinoma in situ (DCIS); >1 mm for invasive carcinoma] based on guidelines at the time of accrual.
  
  
  RESULTS
  A total of 75 patients with stage 0-III breast cancer (76 samples) were randomized, mean age 59.6 years with median follow-up 39.5 months. Overall, 21 patients (27.6 %) had positive margins: 14 had undergone BCS and 7 BCS + M (p = 0.005). Of the 21 patients with positive margins, 19 had DCIS on final pathology (OR 7.56; 95 % CI 1.52-37.51).All patients with positive margins were offered re-excision; 11 had negative final margins after re-excision surgery. Overall, 6 patients (8.3 %) developed LRR with recurrence being more common in the BCS group when compared with the BCS + M group (17.2 vs 2.3 %; p = 0.025).
  
  
  CONCLUSIONS
  Taking additional cavity shave margins at the time of initial excision resulted in a reduction in positive margin rate, a decrease in return to operating room for re-excision, and lower LRR.
authors.affiliation: Grady Memorial Hospital, Winship Cancer Institute, Emory University, Atlanta, GA, USA. veronica.c.jones@emory.edu.|Winship Cancer Institute, Emory University, Atlanta, GA, USA. veronica.c.jones@emory.edu.
authors.forename: Veronica
authors.initials: V
authors.lastname: Jones
authors.affiliation: Department of Surgery, Gundersen Health System, La Crosse, WI, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Linebarger
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Perez
authors.affiliation: Grady Memorial Hospital, Winship Cancer Institute, Emory University, Atlanta, GA, USA.|Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Gabram
authors.affiliation: Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Okoli
authors.affiliation: Department of Surgery, Michigan State University, Lansing, MI, USA.
authors.forename: Harvey
authors.initials: H
authors.lastname: Bumpers
authors.affiliation: Department of Pathology, Grady Memorial Hospital, Emory University, Atlanta, GA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Burns
authors.affiliation: Department of Pathology, Grady Memorial Hospital, Emory University, Atlanta, GA, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Mosunjac
authors.affiliation: Grady Memorial Hospital, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006779:Hospitals, Public; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies