Chagpar et al report on their article
in NEJM the results of a 235 patients trial with breast
cancer stage 0 to III who were undergoing partial mastectomy, with or without
resection of selective margins, and further cavity shave margins resected.
The median age of the patients was 61
years (range, 33 to 94). On pathological testing, 54 patients (23%) had
invasive cancer, 45 (19%) had ductal carcinoma in situ, and 125 (53%) had both;
11 patients had no further disease. The median size of the tumor in the
greatest diameter was 1.1 cm (range, 0 to 6.5) in patients with invasive
carcinoma and 1.0 cm (range, 0 to 9.3) in patients with ductal carcinoma in
situ. The rate of positive margins after
partial mastectomy (before randomization) was similar in the shave group and
the no-shave group (36% and 34%, respectively; P=0.69). After randomization,
patients in the shave group had a significantly lower rate of positive margins
than did those in the no-shave group (19% vs. 34%, P=0.01), as well as a lower
rate of second surgery for margin clearance (10% vs. 21%, P=0.02).
The authors concluded that cavity
shaving halved the rates of positive margins among patients with partial mastectomy.
N Engl J Med 2015; 373:503-510
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