Abstract
A recent randomized controlled trial firstly demonstrated that cavity shaving significantly decreased the rate of positive margins and re-excision among partial mastectomy (PM) patients. However, it remains unknown whether cavity shaving should be routinely applied to Chinese breast cancer patients undergoing PM. A total of 408 PM patients undergoing 410 PMs among 1796 surgically treated breast cancer patients at Fudan University Shanghai Cancer Centre from January 2015 to June 2015 were included in our study. Data were analysed with univariate or multivariate analysis. Overall, 11 of 410 cases (2.7%) had positive margins postoperatively. Moreover, only 24.6% of the cases (P<0.05) presented with ductal carcinoma in situ (DCIS), among whom 10.0% obtained positive margins. In multivariate logistic regression analysis, presence of mammographic calcifications was significantly associated with margin positivity (P<0.05, OR=6.06, 95% CI: 1.53-23.91). In conclusion, cavity shaving during PM should not be routinely performed in Chinese breast cancer patients, particularly in highly selected cases with a low prevalence of DCIS. PM patients with preoperative mammographic calcifications were more likely to have positive margins and might benefit more from cavity shaving.
Highlights
A series of important randomized controlled trials (RCTs) consistently demonstrated that partial mastectomy (PM) plus radiation therapy could achieve overall survival rates similar to mastectomy while improving patients’ aesthetic and psychological outcomes established standard status of PM for early breast cancer [1, 2].In contrast to mastectomy patients, PM patients are more likely to develop local recurrence
The median age was 46 years, and the median tumour size was 1.5 cm. 350 of 410 patients (85.4%) had palpable tumors preoperatively and ductal carcinoma in situ (DCIS) components were present in 101 patients postoperatively, accounting for 24.6% of all PM patients (Table 1)
A recent RCT concluded that a significant reduction in the rate of positive margins and re-excision was demonstrated by PM patients with cavity shaving, bringing level I evidence to cavity shaving after years of persistent debate and changing the surgical management of PM treatment [6,7,8]
Summary
A series of important randomized controlled trials (RCTs) consistently demonstrated that partial mastectomy (PM) plus radiation therapy could achieve overall survival rates similar to mastectomy while improving patients’ aesthetic and psychological outcomes established standard status of PM for early breast cancer [1, 2]. In contrast to mastectomy patients, PM patients are more likely to develop local recurrence. Chagpar et al established that PM patients with cavity shaving have a remarkably decreased rate of positive margins and re-excision in a RCT [5], bringing an end to years of retrospective analyses regarding cavity shaving. We sought to address the feasibility of margin shaving in Chinese breast cancer patients in this study describing a Chinese single-institution experience
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