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

Area of Science:

• Surgical Oncology
• Breast Cancer Surgery
• Pathology

Background:

• Positive lumpectomy margins (LM) often lead to re-excision, though residual tumor is absent in about half of cases.
• Investigating alternative methods to reduce re-operation rates after lumpectomy is crucial for patient management.

Purpose of the Study:

• To evaluate if separate cavity margin (CM) excision can safely decrease the need for re-operation in breast-conserving surgery.
• To compare re-operation rates and residual tumor incidence between lumpectomy alone and lumpectomy with CM excision.

Main Methods:

• Retrospective analysis of 237 patients (Group A: lumpectomy alone) and 271 patients (Group B: lumpectomy with CM excision).
• Patients with positive LM (Group A) or positive CM (Group B) underwent re-excision.
• Comparison of re-operation rates and residual tumor detection in re-excision specimens.

Main Results:

• Group A had 21.1% re-operations for positive LM. Group B had 27.3% positive LM, but only 17.0% had tumor in the CM specimen, with 5.5% reaching the CM edge requiring re-excision.
• Residual tumor was found in 56.0% of re-excisions in Group A and 46.7% in Group B.
• Separate CM excision significantly decreased the rate of re-operation for margin involvement.

Conclusions:

• Separate cavity margin excision substantially lowers re-operation rates for involved margins in breast lumpectomy.
• The study suggests that while CM excision reduces re-operations, its impact on the positive predictive value of margin involvement needs careful consideration.
• Long-term follow-up is essential to ascertain if the reduced re-operation rate by CM excision compromises local recurrence rates.