Perpendicular inked versus tangential shaved margins in breast-conserving surgery: Does the method matter? Journal Article


Authors: Wright, M. J.; Park, J.; Fey, J. V.; Park, A.; O'neill, A.; Tan, L. K.; Borgen, P. I.; Cody, H. S. 3rd; Van Zee, K. J.; King, T. A.
Article Title: Perpendicular inked versus tangential shaved margins in breast-conserving surgery: Does the method matter?
Abstract: Background: In breast-conserving surgery (BCS), the method of margin assessment and the definition of a negative margin vary widely. The purpose of this study was to compare the incidence of positive margins and rates of reexcision between two methods of margin assessment at a single institution. Study design: In July 2004, our protocol for margin evaluation changed from perpendicular inked margins (Group A, n = 263) to tangential shaved margins (Group B, n = 261). In Group A, margins were classified as positive, close, and negative. Margins designated as "close" were further defined as: ≤ 1 mm, ≤ 2 mm, and ≤ 3 mm. In Group B, shaved margins (by definition 2 to 3 mm) were reported as positive or negative. Results: The rate of reported "positive" margins was significantly higher in Group B: 127 of 261 (49%) versus 42 of 263 (16%), p < 0.001. But when patients with "positive, close, or both" kinds of margins were combined in Group A, there was no significant difference between the two techniques. Although the shaved margin was 2- to 3-mm thick, the rate of reexcision in Group B was significantly higher when compared with that in patients with "positive, close, or both" ≤ 3 mm margins in Group A (75% versus 52%, p < 0.001). The likelihood of finding residual disease remained the same (27% versus 32%, p = NS). Conclusions: The tangential shaved-margin technique results in a higher proportion of reported positive margins and limits the ability of the surgeon to discriminate among patients with close margins, resulting in a higher rate of reexcision. The fact that many, but not all, patients with positive or close margins in both groups underwent reexcision emphasizes the role of surgical judgment in this setting. Longer followup is required to determine equivalency in rates of local recurrence between these two methods of margin assessment. © 2007 American College of Surgeons.
Keywords: adult; aged; aged, 80 and over; middle aged; surgical technique; clinical assessment; incidence; breast neoplasms; evaluation; breast carcinoma; partial mastectomy; reoperation; mastectomy, segmental
Journal Title: Journal of the American College of Surgeons
Volume: 204
Issue: 4
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2007-04-01
Start Page: 541
End Page: 549
Language: English
DOI: 10.1016/j.jamcollsurg.2007.01.031
PUBMED: 17382212
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 15" - "Export Date: 17 November 2011" - "CODEN: JACSE" - "Source: Scopus"
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MSK Authors
  1. Lee K Tan
    147 Tan
  2. Kimberly J Van Zee
    293 Van Zee
  3. Hiram S Cody III
    242 Cody
  4. Tari King
    186 King
  5. Patrick I Borgen
    253 Borgen
  6. Anna Yong Park
    31 Park
  7. Jane Fey
    66 Fey
  8. Julia Park
    8 Park
  9. Mary Jo M Wright
    4 Wright