title: Additional Cavity Shaving at the Time of Breast-Conserving Surgery Enhances Accuracy of Margin Status Examination.
abstract: We addressed the impact of separate cavity margin excision (shaving) during breast-conserving surgery (BCS) for breast cancer on specimen volume, tumor margin clearance, re-excision rate, local recurrence and survival.
  
  
  
  A retrospective case-matched study was performed on 298 women with stage 0-III breast cancer; 179 patients received shaving (shaving + lumpectomy group; SLG) and 119 patients did not (lumpectomy group; LG).
  
  
  
  The two groups had similar baseline characteristics. The median volume of surgical specimen was 131.9 cc in the SLG versus 134.8 cc in the LG (p = 0.81), and surgical margins were tumor-free in 90.7 % of cases in the LG versus 92.7 % in the SLG (87.1 % before shaving) (p = 0.69). The re-excision rate was 14.3 % in the LG versus 10.6 % in the SLG (p = 0.44). In the SLG, shaving spared 10 (5.6 %) patients from reoperation (positive lumpectomy margins but tumor-free shaving margins) (p = 0.11), and only 2/19 (10.5 %) patients in the SLG had tumor-free response at histological examination of re-excised margins compared with 10/17 (58.8 %) cases in the LG (p = 0.004). Tumor in shavings was found in 44/156 (28.2 %) patients having tumor-free lumpectomy margins. At multivariate analysis, distance of tumor from lumpectomy margins, tumor multifocality, receptor status, and tumor size were related to tumor persistence in shavings. Median follow-up was 27 months (range 23-35), and two patients had tumor relapse in the SLG versus none in the LG (p = 0.16). Overall survival was 100 % in both groups.
  
  
  
  Shaving does not significantly decrease the re-excision rate but provides wider clear margins in most procedures. It ensures more accurate margin examination and decreases false-positive margin rate, without any increase in removed breast-tissue volume.
authors.affiliation: Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy. giacomopata@alice.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pata
authors.affiliation: Department of Medical and Surgical Sciences, 2nd Division of General Surgery, University of Brescia School of Medicine, Brescia, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Bartoli
authors.affiliation: Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Bianchi
authors.affiliation: Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pasini
authors.affiliation: Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Roncali
authors.affiliation: Department of Medical and Surgical Sciences, 2nd Division of General Surgery, Brescia Civic Hospital, Brescia, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Ragni
mesh_terms: D000368:Aged; D001940:Breast / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012086:Reoperation; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods*; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human