Is the systematic circumferential tumor cavity shaving a representative sample for the remaining mammary gland? About 75 cases

摘要

Abstract Introduction The conservative surgery is more and more indicated for breast cancer. However, we still fear local recurrence which is mostly due to residual tumors?. Several techniques have been used to minimize theses residual tumors; one of them is the systematic circumferential tumor cavity shaving (SCTCS). Methods We sampled 75 female patients who had conservative surgery with positive shaved margins in the anatomopathology examination and to whom a complementary treatment with mastectomy have been decided. Results The median age was 48 years old. The median tumor size was 23?mm. In the histological examination of the tumors, 93% were invasive ductal carcinoma associated in 50% of the cases to the presence of ductal carcinoma in situ (DCIS) where all the lumpectomies had clear margin. For the SCTCS, 62,2% were DCIS and in 17,6% of the cases were invasive ductal carcinoma. A complementary treatment with mastectomy was indicated to all the patients. A residual tumor was detected in the remaining mammary gland in 47,7% of the cases out of which 50% were DCIS. Local recurrence happened in three patients (4,6%) after a median of follow up of 36 months. The overall survival and the disease free survival at five years were respectively 83,6% and 75,5%. Conclusion Standardized lumpectomy cavity shaving provides a backup to lumpectomy margins in conservative breast surgery but it can also be used as a sample for the remaining breast, helping to detect the residual tumor, and decreasing the rates of local recurrence after BCT. Highlights ? In all the cases the lumpectomy margins were free of tumor and The SCTCS was positive for tumor cell in the final histological examination. Therefore the tumor was considered multifocal. ? The histological examination of the 65 mastectomy showed a residual tumor in 31cases 47,7%. The most frequent histological types found was DCIS 15 patients (48,4%), followed by IDC in 11 patient (35,5%). ? SCTCS should not be considered as merely an extension of the margin, but also as a sample of the remaining breast tissue to aid in the detection of residual or multifocal disease. ? We also acknowledge that there are weaknesses in our study, as it would have been interesting to evaluate this ratio in a control group including patients who did not undergo systematic cavity shaving. ]]>