Our Summary

This research paper is about a study on two surgical techniques used in breast cancer treatment - Cavity Shave Margins (CSM) and Specimen Shave Margins (SSM). These techniques are used to remove extra tissue around the tumour during breast-conserving surgery (BCS), which is a type of surgery that aims to remove the cancer while keeping as much of the healthy breast as possible.

The study was conducted on 116 breast cancer patients who had undergone BCS and either CSM or SSM between 2017 and 2019. The goal was to compare the two techniques by looking at the rates of positive margins (meaning there are cancer cells at the edge of the removed tissue), the need for additional surgery to remove more tissue, and the volume of tissue removed.

The results showed that both techniques had similar rates of positive margins and re-operation. However, in the cases where the removed tissue was examined outside of the body (ex vivo), there were fewer instances of cancer cells found at the edges in the SSM group compared to the CSM group. Despite this, the final margins (after all surgeries) were similar for both groups.

The volume of tissue removed in the initial surgery was larger in the SSM group, but the total volume removed after all surgeries was similar for both techniques. Also, for larger tumours (2 cm or more), both techniques had similar results in terms of total tissue removed and final margin positivity rates.

In conclusion, both CSM and SSM are effective techniques for achieving low rates of additional surgery. The results suggest that surgeons can choose either technique based on their preference and still achieve similar outcomes.

FAQs

  1. What is the difference between Cavity Shaving Margin (CSM) and Specimen Shave Margin (SSM)?
  2. How do the re-excision rates compare between patients who received CSM and those who received SSM?
  3. What were the findings on the volumes of shave specimens and the total volume removed in both CSM and SSM procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumpectomy is to discuss with their surgeon the use of cavity shaving margin (CSM) or specimen shave margin (SSM) techniques to reduce the risk of positive margins and the need for re-excision. Both techniques have been shown to be effective in achieving low re-excision rates, so patients should feel comfortable discussing their options with their surgeon to determine the best approach for their individual case.

Suitable For

Patients who are typically recommended lumpectomy include those with early-stage breast cancer, small tumors, and tumors that are easily removed while preserving the breast tissue. Lumpectomy may also be recommended for patients who have tumors that are located in a favorable position within the breast and for those who are not candidates for or prefer to avoid mastectomy. Additionally, lumpectomy may be recommended for patients who have undergone neoadjuvant therapy to shrink the tumor before surgery.

Timeline

  • Patient undergoes lumpectomy procedure
  • Surgeon performs either cavity shaving margin (CSM) or specimen shave margin (SSM) technique
  • Primary margins are assessed for positivity or closeness
  • If margins are positive, additional tissue may be removed through re-excision
  • Final shave margins are assessed for adequacy
  • Volume of tissue removed is compared between CSM and SSM techniques
  • Results show similar rates of final margin positivity and re-excision between CSM and SSM techniques
  • Surgeons may choose to continue using their preferred technique based on individual outcomes and preferences.

What to Ask Your Doctor

  1. What is the difference between cavity shaving margin (CSM) and specimen shave margin (SSM) procedures for lumpectomy?
  2. What are the potential benefits and drawbacks of each technique?
  3. How do CSM and SSM procedures affect the likelihood of positive margins and the need for re-excision?
  4. How will the choice between CSM and SSM impact my recovery time and overall outcome?
  5. Are there any specific factors about my individual case that make one technique more suitable than the other?
  6. What is the surgeon’s experience and preference in performing CSM or SSM procedures?
  7. Are there any potential risks or complications associated with either technique that I should be aware of?
  8. How will the decision between CSM and SSM affect the amount of breast tissue removed during the lumpectomy?
  9. Can you provide any additional information or resources to help me better understand and make an informed decision about my lumpectomy procedure?

Reference

Authors: Iwai Y, Prigoff JG, Sun L, Wiechmann L, Taback B, Rao R, Ugras SK. Journal: J Surg Res. 2022 Sep;277:296-302. doi: 10.1016/j.jss.2022.04.027. Epub 2022 May 5. PMID: 35526391