Veronica Jones1,2, Jared Linebarger3, Sebastian Perez4, Sheryl Gabram5,4, Joel Okoli6, Harvey Bumpers7, Brian Burns8, Marina Mosunjac8, Monica Rizzo5. 1. Grady Memorial Hospital, Winship Cancer Institute, Emory University, Atlanta, GA, USA. veronica.c.jones@emory.edu. 2. Winship Cancer Institute, Emory University, Atlanta, GA, USA. veronica.c.jones@emory.edu. 3. Department of Surgery, Gundersen Health System, La Crosse, WI, USA. 4. Winship Cancer Institute, Emory University, Atlanta, GA, USA. 5. Grady Memorial Hospital, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 6. Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA. 7. Department of Surgery, Michigan State University, Lansing, MI, USA. 8. Department of Pathology, Grady Memorial Hospital, Emory University, Atlanta, GA, USA.
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 % CI1.52-37.51).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.
RCT Entities:
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: S E Tevis; H B Neuman; E A Mittendorf; H M Kuerer; I Bedrosian; S M DeSnyder; A M Thompson; D M Black; M E Scoggins; A A Sahin; K K Hunt; A S Caudle Journal: Ann Surg Oncol Date: 2018-06-26 Impact factor: 5.344
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