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. 2023 Jan;105(1):56-61.
doi: 10.1308/rcsann.2021.0285. Epub 2022 Feb 17.

Routine four-quadrant cavity shaving at the time of wide local excision for breast cancer reduces re-excision rate

F Savioli  1 , E S Morrow  1 , L K Cheung  2 , S Stallard  3 , J Doughty  3 , L Romics  1   3
Affiliations

Routine four-quadrant cavity shaving at the time of wide local excision for breast cancer reduces re-excision rate

F Savioli et al. Ann R Coll Surg Engl. 2023 Jan.

Abstract

Introduction: Breast conservation therapy (BCT) has been shown to have comparable long-term survival outcomes when compared with mastectomy. Clearance of excision margin is one of the mainstays of the surgical treatment, which if not achieved at the first operation of BCT results in the need for subsequent surgery.

Methods: This study evaluated the impact of routinely taken cavity shavings on re-excision rates. This retrospective two-centre study describes the use of routine four-quadrant cavity shaving in 449 patients with consecutively treated with wide local excision for invasive cancer or ductal carcinoma in situ.

Results: The overall incomplete excision rate was 10.6%. Routine cavity shaving prevented the need for re-excision in 84 patients (18.7%) and identified the need for further re-excision in 33 patients (7.3%). Median time from surgery to radiotherapy was 50 days (range 13-209) for non-re-excised patients versus 78 days (range 47-260) for re-excised patients (p<0.001). Median time to chemotherapy (n=75) was 44 days (range 14-106) for non-re-excised patients versus 56 days (range 35-116) for re-excised patients (p=0.017).

Conclusions: This study demonstrates that routine cavity shaving decreases re-excision rate in patients treated with wide local excision and prevents delays to adjuvant treatment due to incomplete excision.

Keywords: Breast cancer; Breast conservation therapy; Chemotherapy (adjuvant); Margins of excision; Radiotherapy (adjuvant).

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Conflict of interest statement

The authors declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Figure 1
Figure 1
Diagrammatic representation of the surgical WLE specimen and orientation of four-quadrant CSs. The ‘tumour facing’ portion of each cavity shaving was marked with a suture to aid with pathological orientation, thus allowing identification of the outer margin CS. CS = cavity shaving; WLE = wide local excision.
See this image and copyright information in PMC

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