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Vanni G, Pellicciaro M, Materazzo M, Marsella V, Usai V, Noce A, Buonomo OC. Impact of cavity shave margins in patients with ductal carcinoma in situ undergoing conserving breast surgery. Front Oncol 2024; 14:1403069. [PMID: 38817901 PMCID: PMC11137221 DOI: 10.3389/fonc.2024.1403069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/29/2024] [Indexed: 06/01/2024] Open
Abstract
Aim The main challenge during breast-conserving surgery (BCS) is to obtain clear margins, especially in patients with ductal carcinoma in situ (DCIS) due to the absence of well-defined nodules. Many surgical approaches have been used in an attempt to reduce the positive margin rate. The aim of this retrospective study is to compare the cavity shave margin technique with standard surgery and the intraoperative evaluation of surgical margins. Methods This is a single-center retrospective study analyzing margin status, need for re-excision, and surgical time in a cohort of 227 patients who underwent surgery from September 2016 to September 2022. Results In patients subjected to cavity shaving, we reported a significant reduction in positive margins of 17.1% versus 28.7% (p-value = 0.042). Also, a difference in terms of surgical re-excision was reported as p-value = 0.039 (12.4% versus 23.8%, respectively, for the cavity shave and control group). In the multivariate analysis, intraoperative evaluation of the margins was a risk factor for margins re-excision (Wald = 4.315, p = 0.038, OR: 2.331 [95% CI: 1.049-5.180]). Surgical time was lower in patients subjected to cavity shaves (p = 0.024), and the relative mean time was 68.4 min ± 37.1 min in the cavity shave group versus 93.9 min ± 40.6 min in the control group. Conclusion The cavity shave margin technique in conserving breast surgery results in a reduction in positive margin rate, surgical re-excision, and operative time.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Rome, Italy
- PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Rome, Italy
- PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, Rome, Italy
| | - Valentina Marsella
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Rome, Italy
| | - Valeria Usai
- PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, Rome, Italy
| | - Annalisa Noce
- UOSD Nephrology and Dialysis, Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Oreste Claudio Buonomo
- University of Basilicata, Potenza, Italy
- Breast Unit, Policlinico Tor Vergata, Rome, Italy
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Vanni G, Pellicciaro M, Renelli G, Materazzo M, Sadri A, Marsella VE, Tacconi F, Bastone SA, Longo B, Di Mauro G, Cervelli V, Berretta M, Buonomo OC. Cavity Shave Margins in Breast Conservative Surgery a Strategy to Reduce Positive Margins and Surgical Time. Curr Oncol 2024; 31:511-520. [PMID: 38248120 PMCID: PMC10814307 DOI: 10.3390/curroncol31010035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Background: Resection of additional tissue circumferentially around the cavity left by lumpectomy (cavity shave) was suggested to reduce rates of positive margins and re-excision. Methods: A single center retrospective study which analyzed margins status, re-excision, and surgical time in patients who underwent breast conserving surgery and cavity shave or intraoperative evaluation of resection margins. Results: Between 2021 and 2023, 594 patients were enrolled in the study. In patients subjected to cavity shave, a significant reduction in positive, focally positive, or closer margins was reported 8.9% vs. 18.5% (p = 0.003). No difference was reported in terms of surgical re-excision (p < 0.846) (5% vs. 5.5%). Surgical time was lower in patients subjected to cavity shave (<0.001). The multivariate analysis intraoperative evaluation of sentinel lymph node OR 1.816 and cavity shave OR 2.909 were predictive factors for a shorter surgical time. Excluding patients subjected to intraoperative evaluation of sentinel lymph node and patients with ductal carcinoma in situ, patients that underwent the cavity shave presented a reduced surgical time (67.9 + 3.8 min vs. 81.6 + 2.8 min) (p = 0.006). Conclusions: Cavity shaving after lumpectomy reduced the rate of positive margins and it was associated with a significant reduction in surgical time compared to intraoperative evaluation of resection margins.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (G.R.); (M.M.); (V.E.M.); (B.L.); (O.C.B.)
| | - Marco Pellicciaro
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (G.R.); (M.M.); (V.E.M.); (B.L.); (O.C.B.)
- PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy;
| | - Giulia Renelli
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (G.R.); (M.M.); (V.E.M.); (B.L.); (O.C.B.)
| | - Marco Materazzo
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (G.R.); (M.M.); (V.E.M.); (B.L.); (O.C.B.)
- PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy;
| | - Amir Sadri
- Plastic Surgery, Great Ormond Hospital for Children NHS Foundation Trust, London WC1N3JH, UK;
| | - Valentina Enrica Marsella
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (G.R.); (M.M.); (V.E.M.); (B.L.); (O.C.B.)
| | - Federico Tacconi
- Unit of Thoracic Surgery, Department of Surgical Sciences, Tor Vergata University, 00133 Rome, Italy;
| | - Sebastiano Angelo Bastone
- PhD Program in Applied Medical-Surgical Sciences, Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy;
- Unit of Thoracic Surgery, Department of Surgical Sciences, Tor Vergata University, 00133 Rome, Italy;
| | - Benedetto Longo
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (G.R.); (M.M.); (V.E.M.); (B.L.); (O.C.B.)
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy;
| | - Giordana Di Mauro
- Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, 98122 Messina, Italy;
| | - Valerio Cervelli
- Plastic and Reconstructive Surgery at Department of Surgical Science, Tor Vergata University, 00133 Rome, Italy;
| | - Massimiliano Berretta
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Oreste Claudio Buonomo
- Breast Unit Policlinico Tor Vergata, Department of Surgical Science, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy; (G.V.); (M.P.); (G.R.); (M.M.); (V.E.M.); (B.L.); (O.C.B.)
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Anselmi KF, Urban C, Dória MT, Urban LABD, Sebastião AP, Kuroda F, Rabinovich I, Cordeiro AAF, Nissen LP, Schunemann E, Spautz C, Pelanda JDC, de Lima RS, Rietjens M, Loureiro MDP. Prospective study: Impact of breast magnetic resonance imaging on oncoplastic surgery and on indications of mastectomy in patients who were previously candidates to breast conserving surgery. Front Oncol 2023; 13:1154680. [PMID: 37007081 PMCID: PMC10060853 DOI: 10.3389/fonc.2023.1154680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundRoutine use of magnetic resonance imaging (MRI) in the staging of patients with early breast cancer is still controversial. Oncoplastic surgery (OP) allows for wider resections without compromising the aesthetic results. This study aimed to assess the impact of preoperative MRI on surgical planning and on indications of mastectomy.MethodsProspective study including T1-T2 breast cancer patients treated between January 2019 and December 2020 in the Breast Unit of the Hospital Nossa Senhora das Graças in Curitiba, Brazil. All patients had indication for breast conserving surgery (BCS) with OP and did a breast MRI after conventional imaging.Results131 patients were selected. Indication for BCS was based on clinical examination and conventional imaging (mammography and ultrasound) findings. After undergoing breast MRI, 110 patients (84.0%) underwent BCS with OP and 21 (16.0%) had their surgical procedure changed to mastectomy. Breast MRI revealed additional findings in 52 of 131 patients (38%). Of these additional findings, 47 (90.4%) were confirmed as invasive carcinoma. Of the 21 patients who underwent mastectomies, the mean tumor size was 2.9 cm (± 1,7cm), with all having additional findings on breast MRI (100% of the mastectomies group vs 28.2% of the OP, p<0.01). Of the 110 patients submitted to OP, the mean tumor size was 1,6cm (± 0,8cm), with only 6 (5.4%) presenting positive margins at the final pathology assessment.ConclusionPreoperative breast MRI has an impact on the OP scenario, bringing additional information that may help surgical planning. It allowed selecting the group with additional tumor foci or greater extension to convert to mastectomy, with a consequent low reoperation rate of 5.4% in the BCS group. This is the first study to assess the impact of breast MRI in the preoperative planning of patients undergoing OP for the treatment of breast cancer.
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Affiliation(s)
- Karina Furlan Anselmi
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
- Post-Graduation Program in Biotechnology, Universidade Positivo, Curitiba, Brazil
- *Correspondence: Karina Furlan Anselmi,
| | - Cicero Urban
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Maíra Teixeira Dória
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
- Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Brazil
| | | | | | - Flávia Kuroda
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | - Iris Rabinovich
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
- Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Brazil
| | | | | | - Eduardo Schunemann
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
- Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Brazil
| | - Cleverton Spautz
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, Brazil
| | | | | | - Mario Rietjens
- Plastic and Reconstructive Surgery Department, European Institute of Oncology, Milan, Italy
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Mohamedahmed AYY, Zaman S, Zafar S, Laroiya I, Iqbal J, Tan MLH, Shetty G. Comparison of surgical and oncological outcomes between oncoplastic breast-conserving surgery versus conventional breast-conserving surgery for treatment of breast cancer: A systematic review and meta-analysis of 31 studies. Surg Oncol 2022; 42:101779. [DOI: 10.1016/j.suronc.2022.101779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/01/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
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Mansilla-Polo M, Ruiz-Merino G, Marín-Rodríguez P, Iborra-Lacal E, Guzmán-Aroca F, M Servet Pérez de Lema C, Marín-Hernández C, Polo-García L, Piñero-Madrona A. Cavity shaving for invasive breast cancer conservative surgery: Reduced specimen volume and margin positive rates. Surg Oncol 2021; 38:101632. [PMID: 34274752 DOI: 10.1016/j.suronc.2021.101632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/01/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The cavity shaving (CS) technique was described in breast conserving surgery to reduce the rate of reoperation avoiding the need for intraoperative margin analysis. This study assesses differences in the rates of involvement of the surgical margin (requiring further surgery) and volume of surgical specimens, depending on the use or not of this technique. MATERIAL AND METHODS A retrospective cohort study was conducted in patients with breast carcinoma who underwent breast conserving surgery between 2013 and 2019. They were divided into two groups depending on whether the cavity shaving technique was used or not. Primary outcomes of the study included presence of final margin involvement, requiring need for further surgery, and the volume of excised tissue comparing the study groups. RESULTS A total of 202 cases were included: 92 in the control group and 110 in the cavity shaving group. Significant differences were found regarding involvement of the final margin (19.57% control group vs. 4.55% cavity shaving group; p = 0.010). The volume of additional surgical specimens were significantly greater in the traditional technique group than in the shaving technique (46.43 vs 13.32 cm3; p = 0.01) as was total specimen volume (143.40 vs 100.63 cm3; p = 0.022). CONCLUSIONS CS can reduce the positive margin and re-excision rates without larger-volume resections and should therefore be considered a routine technique in BCS for early-stage breast cancer.
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Affiliation(s)
- Miguel Mansilla-Polo
- Surgery Department. Hospital Clínico Universitario "Virgen de La Arrixaca". Murcia. Spain. Instituto Murciano de Investigación Biosanitaria (IMIB), Spain
| | - Guadalupe Ruiz-Merino
- Biostatistics Department. Fundación para la Formación e Investigación Sanitaria (FFIS), Murcia, Spain
| | - Pedro Marín-Rodríguez
- Surgery Department. Hospital Clínico Universitario "Virgen de La Arrixaca". Murcia. Spain. Instituto Murciano de Investigación Biosanitaria (IMIB), Spain
| | - Emma Iborra-Lacal
- Pathology Department. Hospital Clínico Universitario "Virgen de La Arrixaca", Murcia, Spain
| | | | | | - Caridad Marín-Hernández
- Surgery Department. Hospital Clínico Universitario "Virgen de La Arrixaca". Murcia. Spain. Instituto Murciano de Investigación Biosanitaria (IMIB), Spain
| | - Luis Polo-García
- Pathology Department. Hospital Clínico Universitario "Virgen de La Arrixaca", Murcia, Spain
| | - Antonio Piñero-Madrona
- Surgery Department. Hospital Clínico Universitario "Virgen de La Arrixaca". Murcia. Spain. Instituto Murciano de Investigación Biosanitaria (IMIB), Spain.
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Operable breast cancer: How not to worsen the prognosis, especially in triple negative and stage II tumors. Surg Oncol 2021; 38:101596. [PMID: 34015750 DOI: 10.1016/j.suronc.2021.101596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Oncological surgery must follow some fundamental principles to be truly curative, one of which is the resection of the tumor with surgical margins free of neoplasia. In breast cancer, surgery with positive margins should be expanded immediately. There are probably different intensities, between the stages and molecular subtypes of operable breast cancer, of worsening prognosis due to the surgical margin compromised by the neoplasia in women not submitted to the necessary enlargement of the positive surgical margin. MATERIALS AND. METHODS Seven hundred and forty-seven women with invasive ductal carcinoma of the breast, analyzing anatomical-pathological information, types of surgery, molecular subtypes, and the presence or absence of the surgical margin compromised by neoplasia. RESULTS Sixty-one (8.2%) patients had positive surgical margin, causing 2.85 times more risk of locoregional relapse compared to negative surgical margin by multivariate analysis. In subgroup analysis, among stages I, II and III, stage II was the most negatively impacted, with those patients presenting 2.42 times more risk of distant metastasis and 4.94 times more risk of locoregional relapses compared to negative surgical margin by multivariate analysis. Among the molecular subtypes, Triple Negative tumors with a positive surgical margin had 3.56 times more risk of death, 4.98 times more risk of distant metastasis and 5.55 times more risk of locoregional relapse compared to negative surgical margin by multivariate analysis. CONCLUSIONS The positive surgical margin, especially in Stage II and Triple-Negative breast cancer patients negatively impact the patient's evolution, increasing risk of distant metastasis and death.
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