Cavity margins and lumpectomy margins for pathological assessment: Which is superior in breast-conserving surgery?

• Published in: The Journal of surgical research 2012-12, Vol.178 (2), p.751-757
• Main Authors: Yang, Hua, MD, Jia, Weijuan, MD, Chen, Kai, MD, Zeng, Yunjie, MD, Li, Shunrong, MD, Jin, Liang, MD, Wang, Lin, MD, Song, Erwei, MD, PhD, Su, Fengxi, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Breast-conserving surgery; Cavity margin; Cohort Studies; Female; Humans; Lumpectomy margin; Mastectomy, Segmental - methods; Middle Aged; Prospective Studies; Surgery
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2012.05.030

Abstract Purpose This prospective cohort study aimed to compare the efficacy of cavity margins (CMs) and lumpectomy margins (LMs) for pathological assessment in breast-conserving surgery. Methods We assessed the CMs and LMs of 163 breast cancer patients during breast-conserving surgery. We compared and analyzed the positivity rates of CM and LM. Results The positivity rate of CM at the case level and individual margin level was 30.7% and 8.0%, respectively. The positivity rate of LM was 12.3%, 33.1%, and 45.4% at the case level and 1.8%, 6.2%, and 9.1% at the individual margin level, when we used the National Surgical Adjuvant Breast and Bowel Project criteria (ink-free), 1 mm-free criteria and 2 mm-free criteria, respectively. The positivity rate of LM with 1 mm-free criteria was similar to that of CM. Delivery of neoadjuvant chemotherapy increased the positivity rate of CM (50.0% versus 25.2%; P < 0.01) but not LM (41.6% versus 30.7%; P > 0.05) at the case level, whereas the positivity rate of CM and LM both increased after neoadjuvant chemotherapy at the margin level (CMs: 15.5% versus 5.6%, P < 0.001; and LMs: 10.7% versus 4.9%, P < 0.001). In univariate and multivariate analysis, delivery of neoadjuvant chemotherapy, higher node-positive stage, and presence of ductal carcinoma in situ component were correlated with positive CM, whereas positive human epidermal growth factor receptor 2 status and higher node-positive stage were associated with positive LM. Conclusions Ink-free criteria may be insufficient for LM assessment in breast-conserving surgery, and at least 1 mm width LM is suggested. After the delivery of neoadjuvant chemotherapy, CM assessment should be routinely performed in addition to LM assessment.