Prognostic factors for residual occult disease in shave margins during partial mastectomy

Abstract

PurposeShave margins have been shown to decrease positive final margins in partial mastectomy. We investigated prognostic factors associated with residual disease in shave margins.Methods
Patients with invasive breast carcinoma and ductal carcinoma in situ (DCIS) who had circumferential shave margins excised during lumpectomy were abstracted from a retrospective database from 2015 to 2018. We defined residual occult disease (ROD) as either (1) residual disease in a shave margin when the initial lumpectomy specimen had negative margins or (2) residual disease in a shave margin that did not correspond with the positive lumpectomy margin. We identified the frequency of ROD and conducted logistic regression analysis to identify associated prognostic factors.Results166 Patients (139 invasive carcinoma, 27 DCIS) were included with median follow-up of 28 months (9–50 months). Residual occult disease existed in 34 (24.5%) with invasive carcinoma and 8 (29.6%) with DCIS. In univariate analyses of the invasive group, invasive lobular carcinoma and a positive initial, non-corresponding lumpectomy margin were predictive of ROD (OR 3.63, p = 0.04, OR 3.48, p = 0.003 respectively). In multivariate analysis, a positive lumpectomy margin remained significant, p = 0.007. No variables were associated with ROD in DCIS.Conclusion
Residual occult disease was shown to be a frequent event in this analysis of lumpectomy with circumferential shave margins. Having a positive initial lumpectomy margin was predictive of ROD in a non-corresponding margin. Surgeons should consider not being selective in their shave margins or margin of re-excision if shave margins were not obtained in their initial surgery.

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Breast Cancer Research and Treatment (2021) 189:471–481
https://doi.org/10.1007/s10549-021-06282-9
EPIDEMIOLOGY
Prognostic factors forresidual occult disease inshave margins
duringpartial mastectomy
JulieB.Siegel1 · RupakMukherjee1· YeonheePark2· AbbieR.Cluver3· CatherineChung1· DavidJ.Cole1·
MarkA.Lockett1· NancyKlauber‑DeMore1· AndreaM.Abbott1
Received: 2 April 2021 / Accepted: 31 May 2021 / Published online: 16 June 2021
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021
Abstract
Purpose Shave margins have been shown to decrease positive final margins in partial mastectomy. We investigated prognostic
factors associated with residual disease in shave margins.
Methods Patients with invasive breast carcinoma and ductal carcinoma insitu (DCIS) who had circumferential shave margins
excised during lumpectomy were abstracted from a retrospective database from 2015 to 2018. We defined residual occult
disease (ROD) as either (1) residual disease in a shave margin when the initial lumpectomy specimen had negative margins
or (2) residual disease in a shave margin that did not correspond with the positive lumpectomy margin. We identified the
frequency of ROD and conducted logistic regression analysis to identify associated prognostic factors.
Results 166 Patients (139 invasive carcinoma, 27 DCIS) were included with median follow-up of 28months (9–50months).
Residual occult disease existed in 34 (24.5%) with invasive carcinoma and 8 (29.6%) with DCIS. In univariate analyses of
the invasive group, invasive lobular carcinoma and a positive initial, non-corresponding lumpectomy margin were predic-
tive of ROD (OR 3.63, p = 0.04, OR 3.48, p = 0.003 respectively). In multivariate analysis, a positive lumpectomy margin
remained significant, p = 0.007. No variables were associated with ROD in DCIS.
Conclusion Residual occult disease was shown to be a frequent event in this analysis of lumpectomy with circumferential
shave margins. Having a positive initial lumpectomy margin was predictive of ROD in a non-corresponding margin. Surgeons
should consider not being selective in their shave margins or margin of re-excision if shave margins were not obtained in
their initial surgery.
Keywords Shave margins· Breast cancer· Lumpectomy· Partial mastectomy· Residual disease
Introduction
It is estimated that 10–40% of women that undergo breast
conservation surgery for invasive carcinoma or ductal carci-
noma insitu (DCIS) have a positive margin on final surgical
pathology [1, 2]. A positive margin leads to recommenda-
tions of re-excision due to a significant risk of locoregional
recurrence [3]. Re-excision presents risks of further sur-
gery, potential cosmetic compromise, and delay in adjuvant
therapy [4]. In 2015, a randomized controlled trial investi-
gated the difference in positive final margins and need for
re-excision between patients that had additional cavity shave
margins and those who did not for Stage 0–III breast cancer
[5]. The study found that patients undergoing lumpectomy
with cavity shave margins had significantly lower rates of
positive final margins and need for re-excision compared to
patients who had standard lumpectomy [5]. As a result of
this trial, and additional supporting studies, many surgeons
have adopted the practice of performing routine cavity shave
margins to decrease their overall positive margin rate [6, 7].
However, this is not an established standard of care, and
Accepted as a poster presentation at the 2020 Society of Surgical
Oncology International Conference on Surgical Cancer Care.
* Julie B. Siegel
siegelju@musc.edu
1 Department ofSurgery, Medical University ofSouth
Carolina, 171 Ashley Ave., Charleston, SC29425, USA
2 Department ofPublic Health Science, Medical University
ofSouth Carolina, Charleston, SC, USA
3 Department ofRadiology andRadiologic Science, Medical
University ofSouth Carolina, Charleston, SC, USA
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