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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2014

01-01-2014 | Breast Oncology

Impact of Margin Assessment Method on Positive Margin Rate and Total Volume Excised

Authors: Tracy-Ann Moo, MD, Lydia Choi, MD, Candice Culpepper, MD, Cristina Olcese, BS, Alexandra Heerdt, MD, Lisa Sclafani, MD, Tari A. King, MD, Anne S. Reiner, MPH, Sujata Patil, PhD, Edi Brogi, MD, Monica Morrow, MD, Kimberly J. Van Zee, MS, MD

Published in: Annals of Surgical Oncology | Issue 1/2014

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Abstract

Background

For breast-conserving surgery, the method of margin assessment that most frequently achieves negative margins without increasing the volume of tissue excised is uncertain. We examined our institutional experience with three different margin assessment methods used by six experienced breast surgeons.

Methods

Patients undergoing breast-conserving surgery for invasive carcinoma during July to December of a representative year during which each method was performed (perpendicular, 2003; tangential, 2004; cavity shave, 2011) were included. The effect of margin method on the positive margin rate at first excision and the total volume excised to achieve negative margins were evaluated by multivariable analysis, by surgeon, and by tumor size and presence of extensive intraductal component (EIC).

Results

A total of 555 patients were identified, as follows: perpendicular, 140; tangential, 124; and cavity shave, 291. The tangential method had a higher rate of positive margins at first excision than the perpendicular and cavity-shave methods (49, 15, 11 %, respectively; p < 0.0001). Median volumes to achieve negative margins were similar (55 ml perpendicular; 64 ml tangential; 62 ml cavity shave; p = 0.24). Four of six surgeons had the lowest rate of positive margins with the cavity-shave method, which was significant when compared to the tangential method (p < 0.0001) but not the perpendicular method (p = 0.37). The volume excised by the three methods varied by surgeon (p < 0.0001). The perpendicular method was optimal for T1 tumors without EIC; the cavity-shave method tended to be superior for T2–T3 tumors and/or EIC.

Conclusions

Although the cavity-shave method may decrease the rates of positive margins, its effect on volume is variable among surgeons and may result in an increase in the total volume excised for some surgeons and for small tumors without EIC.
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Metadata
Title
Impact of Margin Assessment Method on Positive Margin Rate and Total Volume Excised
Authors
Tracy-Ann Moo, MD
Lydia Choi, MD
Candice Culpepper, MD
Cristina Olcese, BS
Alexandra Heerdt, MD
Lisa Sclafani, MD
Tari A. King, MD
Anne S. Reiner, MPH
Sujata Patil, PhD
Edi Brogi, MD
Monica Morrow, MD
Kimberly J. Van Zee, MS, MD
Publication date
01-01-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 1/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3257-2

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