Cavity shave technique for safe resection margins in breast cancer conserving surgery: a randomized clinical trial

In the modern era, breast surgery aims to adopt conservative strategies that ensure both oncological safety and aesthetic outcomes. However, one of the major challenges is the risk of positive margins, which may require a second surgery. Various strategies have been adopted to minimize this risk. The most commonly used strategies include the selective resection of suspicious margins after intraoperative evaluation and the routine circumferential resection of additional tissue around the cavity left by a lumpectomy, known as the Cavity-Shave (CS) Technique.

A blind randomized clinical trial was conducted, in which standard selective margin resections were compared to the CS technique, in a 1:1 ratio, comparing oncological outcomes, aesthetic results, and surgical time.

A total of 185 patients were enrolled in the study, with a mean age of 62.04 ± 14.02. The sample was randomly assigned to two groups: 91(49.2 %) were allocated to the cavity shave (CS) Group and 94 (50.8 %) to the no-CS-Group. The rate of positive margins was 20.9 % versus 18.1 %, p-value:0.631 vs p-value:0.577. The re-excision rate was 12.1 % vs 14.9 %, in the CS-group and in the no-Cs-Group respectively. The mean operating room occupancy time was 77.9 ± 23.5 min in the CS-group versus 95.6 ± 34.9 min in the no-Cs-Group, with a p-value<0.001. Aesthetic outcomes were comparable between the two groups (p-value:0.706), despite a statistically significant difference in the total volume excised, 67.2 ± 16.4 cm³ in the CS-Group versus 51.5 ± 17.2 cm³ in the no-CS-Group, p-value:0.021.

CS and selective margin resection with intraoperative histopathological evaluation showed similar oncological and aesthetic outcomes; however, CS was associated with a statistically significant reduction in surgical time.