Impact of Cavity Shaving on Margin Status and Re-excision Rates in Breast-Conserving Surgery: Experience from a Single Institute Cavity shaving in breast-conserving surgery

Deepti Jain (1), Sara Abbott (2), Fadi Zaiem (3), Marya Wahidi (4), Zade Kazziha (5), Nagla E Salem (6), Mayyadah Al-Nuaimi (7), Hyejeong Jang (8), Seongho Kim (9), Sudeshna Bandyopadhyay (10), Rouba Ali-Fehmi (11)
(1) Department of Pathology, Wayne State University, Detroit, MI, USA, United States,
(2) Department of Pathology, University of Michigan, Ann Arbor, MI, USA, United States,
(3) Creighton University School of Medicine, Phoenix, Arizona, USA, United States,
(4) Department of Pathology, Wayne State University, Detroit, MI, USA, United States,
(5) Department of Pathology, University of Michigan, Ann Arbor, MI, USA, United States,
(6) Henry Ford St. John Hospital, Detroit , United States,
(7) Department of Pathology, University of Michigan, Ann Arbor, MI, USA, United States,
(8) Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, United States,
(9) Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, United States,
(10) Henry Ford St. John Hospital, Detroit, MI, USA, United States,
(11) Department of Pathology, Wayne State University, Detroit, MI, USA, United States

Article Sidebar

Issue
Vol. 13 No. 2 (2026): In-Press Volume 13, Issue 2, May 2026
Keywords:
    Breast-conserving surgery, breast neoplasms, surgical margins, reoperation
No galleys available

Abstract

Background: The comparative outcomes of breast-conserving surgery (BCS) with and without cavity shave margins (CSM) are not well established, despite prior randomized and observational studies, due to heterogeneity in patient populations and margin definitions. We aim to evaluate the impact of each procedure on final margin status and subsequent re-excision rates.


Methods: We conducted a retrospective study comprising 529 females who underwent either BCS with CSM or BCS without CSM between 2013 and 2015 for ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), or both at Detroit Medical Centre, Michigan. Data, including final margins status (inked and close margin) and re-excision status, were collected. Statistical analysis was performed using univariable and multivariable logistic regression analyses.


Results: Our analysis revealed no significant reduction in the incidence of positive margins (involved and tumor within 2 mm) among patients who underwent either procedure. In the univariable analysis, patients without lymph node (LN) metastases, those who underwent BCS with CSM procedure, and those with pure IDC had a decreased risk of re-excision compared to those without LN sampling and those with only DCIS (all p<0.001), respectively. These factors also remained significant in multivariable analysis.


Conclusion: Although no significant difference was observed between the two procedures in reducing the incidence of positive margins among patients with only IDC, only DCIS, and both IDC and DCIS, CSM showed a lower need for re-excision, particularly in cases with pure IDC.

Full text article

Generated from XML file

References

American Cancer Society. Breast Cancer Facts & Figures 2024-2025 [Available from: https://www.cancer.org/research/cancer-facts-statistics/breast-cancer-facts-figures.html.

Keelan S, Flanagan M, Hill ADK. Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers. Front Oncol. 2021;11:622621. doi: 10.3389/fonc.2021.622621

Kelly BN, Kantor O, Tang R, Coopey SB, Smith BL, Lanahan CR, et al. Similar rates of residual disease in patients with DCIS within 2 mm of lumpectomy margin regardless of the presence of invasive carcinoma. Breast Cancer Res Treat. 2021;186(3):807-14. doi: 10.1007/s10549-020-06026-1

Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383-93. doi: 10.1016/s0002-9610(02)01012-7

Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol. 2014;21(3):717-30. doi: 10.1245/s10434-014-3480-5

McCahill LE, Single RM, Aiello Bowles EJ, Feigelson HS, James TA, Barney T, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467-75. doi: 10.1001/jama.2012.43

Wilke LG, Czechura T, Wang C, Lapin B, Liederbach E, Winchester DP, et al. Repeat surgery after breast conservation for the treatment of stage 0 to II breast carcinoma: a report from the National Cancer Data Base, 2004-2010. JAMA Surg. 2014;149(12):1296-305. doi: 10.1001/jamasurg.2014.926

Metcalfe LN, Zysk AM, Yemul KS, Jacobs LK, Oker EE, Underwood HR, et al. Beyond the Margins-Economic Costs and Complications Associated With Repeated Breast-Conserving Surgeries. JAMA Surg. 2017;152(11):1084-6. doi: 10.1001/jamasurg.2017.2661

Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233-41. doi: 10.1056/NEJMoa022152

Moran MS, Schnitt SJ, Giuliano AE, Harris JR, Khan SA, Horton J, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol. 2014;32(14):1507-15. doi: 10.1200/JCO.2013.53.3935

Morrow M, Van Zee KJ, Solin LJ, Houssami N, Chavez-MacGregor M, Harris JR, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma In Situ. J Clin Oncol. 2016;34(33):4040-6. doi: 10.1200/JCO.2016.68.3573

Marudanayagam R, Singhal R, Tanchel B, O'Connor B, Balasubramanian B, Paterson I. Effect of cavity shaving on reoperation rate following breast-conserving surgery. Breast J. 2008;14(6):570-3. doi: 10.1111/j.1524-4741.2008.00649.x

Vanni G, Pellicciaro M, Renelli G, Materazzo M, Sadri A, Marsella VE, et al. Cavity Shave Margins in Breast Conservative Surgery a Strategy to Reduce Positive Margins and Surgical Time. Curr Oncol. 2024;31(1):511-20. doi: 10.3390/curroncol31010035

Taghian A, Mohiuddin M, Jagsi R, Goldberg S, Ceilley E, Powell S. Current perceptions regarding surgical margin status after breast-conserving therapy: results of a survey. Ann Surg. 2005;241(4):629-39. doi: 10.1097/01.sla.0000157272.04803.1b

Blair SL, Thompson K, Rococco J, Malcarne V, Beitsch PD, Ollila DW. Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons? J Am Coll Surg. 2009;209(5):608-13. doi: 10.1016/j.jamcollsurg.2009.07.026

Azu M, Abrahamse P, Katz SJ, Jagsi R, Morrow M. What is an adequate margin for breast-conserving surgery? Surgeon attitudes and correlates. Ann Surg Oncol. 2010;17(2):558-63. doi: 10.1245/s10434-009-0765-1

Chagpar AB, Killelea BK, Tsangaris TN, Butler M, Stavris K, Li F, et al. A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer. N Engl J Med. 2015;373(6):503-10. doi: 10.1056/NEJMoa1504473

Huston TL, Pigalarga R, Osborne MP, Tousimis E. The influence of additional surgical margins on the total specimen volume excised and the reoperative rate after breast-conserving surgery. Am J Surg. 2006;192(4):509-12. doi: 10.1016/j.amjsurg.2006.06.021

Cao D, Lin C, Woo SH, Vang R, Tsangaris TN, Argani P. Separate cavity margin sampling at the time of initial breast lumpectomy significantly reduces the need for reexcisions. Am J Surg Pathol. 2005;29(12):1625-32. doi: 10.1097/01.pas.0000180448.08203.70

Corsi F, Sorrentino L, Bonzini M, Bossi D, Truffi M, Amadori R, et al. Cavity Shaving Reduces Involved Margins and Reinterventions Without Increasing Costs in Breast-Conserving Surgery: A Propensity Score-Matched Study. Ann Surg Oncol. 2017;24(6):1516-24. doi: 10.1245/s10434-017-5774-x

Tengher-Barna I, Hequet D, Reboul-Marty J, Frassati-Biaggi A, Seince N, Rodrigues-Faure A, et al. Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast lumpectomy. Mod Pathol. 2009;22(2):299-305. doi: 10.1038/modpathol.2008.186

Chen H, Bai F, Wang M, Zhang M, Zhang P, Wu K. The prognostic significance of co-existence ductal carcinoma in situ in invasive ductal breast cancer: a large population-based study and a matched case-control analysis. Ann Transl Med. 2019;7(18):484. doi: 10.21037/atm.2019.08.16

Fauveau LR, Dao TN, Wallace LB, Mamawala MK, Obaid A, Waddimba AC, et al. Positive surgical margins after breast-conserving surgery for ductal carcinoma in-situ: does histologic grade or estrogen receptor status matter? Breast Cancer Res Treat. 2023;199(2):215-20. doi: 10.1007/s10549-023-06905-3

Authors

Deepti Jain
Department of Pathology, Wayne State University, Detroit, MI, USA
https://orcid.org/0009-0004-3015-1042
Sara Abbott
Department of Pathology, University of Michigan, Ann Arbor, MI, USA
https://orcid.org/0009-0004-3015-1042
Fadi Zaiem
Creighton University School of Medicine, Phoenix, Arizona, USA
https://orcid.org/0009-0002-9252-4276
Marya Wahidi
Department of Pathology, Wayne State University, Detroit, MI, USA
https://orcid.org/0009-0000-9463-2081
Zade Kazziha
Department of Pathology, University of Michigan, Ann Arbor, MI, USA
https://orcid.org/0009-0001-1304-1173
Nagla E Salem
Henry Ford St. John Hospital, Detroit
https://orcid.org/0009-0000-5260-3709
Mayyadah Al-Nuaimi
Department of Pathology, University of Michigan, Ann Arbor, MI, USA
https://orcid.org/0000-0003-0219-2774
Hyejeong Jang
Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine
https://orcid.org/0000-0003-4502-6215
Seongho Kim
Biostatistics and Bioinformatics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine
https://orcid.org/0000-0003-1120-073X
Sudeshna Bandyopadhyay
Henry Ford St. John Hospital, Detroit, MI, USA
https://orcid.org/0009-0004-9352-4133
Rouba Ali-Fehmi
Department of Pathology, Wayne State University, Detroit, MI, USA
https://orcid.org/0009-0003-0642-535X
alifehmi@med.umich.edu (Primary Contact)
1.
Jain D, Abbott S, Zaiem F, Wahidi M, Kazziha Z, E Salem N, et al. Impact of Cavity Shaving on Margin Status and Re-excision Rates in Breast-Conserving Surgery: Experience from a Single Institute : Cavity shaving in breast-conserving surgery. Arch Breast Cancer [Internet]. [cited 2026 Mar. 9];13(2). Available from: https://archbreastcancer.com/index.php/abc/article/view/1247
Download Citation
Endnote/Zotero/Mendeley (RIS)

Copyright (c) 2026 Archives of Breast Cancer

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.

Article Details