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Clinical Outcomes of Breast-Conserving Surgery in Patients Using a Modified Method for Cavity Margin Assessment

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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Abstract

Background

This study describes a modified intraoperative method for cavity margin (CM) assessment in place of lumpectomy margin assessment in patients undergoing breast-conserving surgery (BCS).

Methods

This is a retrospective review of 422 breast cancer patients undergoing BCS with intraoperative CM assessment. After an initial lumpectomy with intent to obtain ≥1-cm margins, separate specimens 1 × 1 cm, 0.5-cm thick were taken from the cavity margin circumferentially. These were frozen without reference to the side of the new margin as a time-saving measure, and parallel sections of the resected surface were evaluated.

Results

After a median follow-up of 55.5 months, a cumulative 5-year locoregional recurrence-free survival rate of 95.3 %, metastasis-free survival rate of 97.8 %, disease-free survival rate of 88.3 %, and overall survival rate of 96.0 %, was achieved. The CM positivity rates were of no statistical difference when <7, 7–8, and >8 CMs were assessed. The second operation rate was 3.5 % because of the false-negative results of the frozen section analysis on CMs. Univariate and multivariate analysis revealed that a higher pN stage and cT stage as well as a lack of adjuvant chemotherapy or radiation demonstrated significantly worse clinical outcomes. Locoregional recurrences and metastasis are both correlated with worse overall survival. The number of the CMs assessed was not associated with clinical outcomes.

Conclusions

The modified CM assessment presented here is a rapid, accurate, and oncologically safe approach for margin evaluation in BCS patients. Lumpectomy margin assessment might be spared when this method is used.

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Acknowledgment

We thank Nicole Howard, Jordan Glancy, and Lance Clark for assisting with graphing and revision of our manuscript. We are also grateful to Zhihao Zheng and Xiayi Wu for full discussion of this research. We also appreciate Jianrong He for instructions on statistical analysis. This work was supported by the National Natural Science Foundation of China (Grants 30972785/H1604 and 30901767/H1611).

Author information

Authors and Affiliations

  1. Department of Breast Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Kai Chen, Haixia Jia MD, WeiJuan Jia MD, Hua Yang MD, Nanyan Rao MD, Erwei Song MD, PhD & Fengxi Su MD

  2. Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

    Yunjie Zeng MD

  3. Department of General Surgery, Second Affiliated Hospital of Guangzhou Medical School, Guangzhou, People’s Republic of China

    Haixia Jia MD

  4. Mammary Therapeutic Center, Henan Province Oncology Hospital, Zhengzhou, People’s Republic of China

    Hua Yang MD

  5. Department of Surgery, University of South Florida College of Medicine, USF Breast Health, Tampa, FL, USA

    Charles E. Cox MD

Authors
  1. Kai Chen
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  2. Yunjie Zeng MD
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  3. Haixia Jia MD
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  4. WeiJuan Jia MD
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  5. Hua Yang MD
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  6. Nanyan Rao MD
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  7. Erwei Song MD, PhD
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  8. Charles E. Cox MD
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  9. Fengxi Su MD
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Corresponding authors

Correspondence to Charles E. Cox MD or Fengxi Su MD.

Additional information

K. Chen, Y. Zeng, and H. Jia contributed equally to this work.

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10434_2012_2331_MOESM1_ESM.pdf

Supplement Table 1 is available for this article at doi:10.1245/s10434-012-2331-5 and is accessible for authorized users. (PDF 39 kb)

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Chen, K., Zeng, Y., Jia, H. et al. Clinical Outcomes of Breast-Conserving Surgery in Patients Using a Modified Method for Cavity Margin Assessment. Ann Surg Oncol 19, 3386–3394 (2012). https://doi.org/10.1245/s10434-012-2331-5

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  • DOI: https://doi.org/10.1245/s10434-012-2331-5

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