Separate cavity margins excision as a complement to conservative breast cancer surgery

Zavagno, G.; Donà, M.; Orvieto, E.; Mocellin, S.; Pasquali, S.; Goldin, E.; Lo Mele, M.; Belardinelli, V.; Nitti, D.

doi:10.1016/j.ejso.2010.05.018

« Previous Next »European Journal of Surgical Oncology
Volume 36, Issue 7 , Pages 632-638, July 2010

Separate cavity margins excision as a complement to conservative breast cancer surgery

G. Zavagno
- Clinica Chirurgica II – Breast Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
- Corresponding author. Tel.: +39 049 8212071; fax: +39 049 651891.
M. Donà
- Clinica Chirurgica II – Breast Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
E. Orvieto
- Anatomia Patologica, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
S. Mocellin
- Clinica Chirurgica II – Breast Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
S. Pasquali
- Clinica Chirurgica II – Breast Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
E. Goldin
- Clinica Chirurgica II – Breast Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
M. Lo Mele
- Anatomia Patologica, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
V. Belardinelli
- Clinica Chirurgica II – Breast Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
D. Nitti
- Clinica Chirurgica II – Breast Unit, University of Padova, Via Giustiniani 2, 35128 Padova, Italy

Accepted 17 May 2010.

Abstract

Background

Positive lumpectomy margins (LM) usually mandate re-excision. However, approximately half of these patients have no residual tumour in the re-excision specimen. The aim of this study was to investigate if separate cavity margin (CM) excision can safely reduce the need of re-operation.

Methods

Rate of re-operation for margin involvement and incidence of residual tumour in the re-excision specimen were retrospectively evaluated in 237 patients (group A) who underwent lumpectomy alone, and in 271 patients (group B) treated by lumpectomy and CM excision. Patients with positive LM (group A) or CM (group B) underwent re-excision.

Results

In the group A, 50/237 patients (21.1%) had LM+ and underwent re-excision. In the group B, 74/271 patients (27.3%) had LM+, but tumour was found within the CM specimen in 46 patients (17.0%), 24 LM+ and 22 LM−, and reached the CM cut edge in only 15 (5.5%), who finally underwent re-excision. Residual tumour was found in the re-excision specimen in 28/50 patients (56.0%) of the group A and in 7/15 patients (46.7%) of the group B.

Conclusions

Separate CM excision strongly decreases the rate of re-operation for involved margin. However, the finding of various combinations of LM and CM status and the evidence that CM excision does not improve the positive predictive value of margin involvement suggest prudent conclusions. Only long term follow up of patients treated according to the CM status can exclude that the reduced rate of re-operations allowed by this procedure would expose to an increased risk of local recurrence.

Keywords: Breast cancer, Breast conservation surgery, Margins, Re-excision, Local recurrence