Shave Margins vs. Standard Partial Mastectomy in Breast Cancer Patients

Some authors have investigated, in a retrospective fashion, the use of routine shave margins,
where surgeons routinely take additional margins at the time of the initial partial
mastectomy as a means of obtaining negative margins. While these retrospective studies have
found that positive margin rates declined using this technique, opponents to this technique
wonder if this truly results in a higher negative margin rate without compromising cosmesis
or increasing tissue volume removed. As these studies were retrospective, it was possible
that the initial resection was smaller than what those who do not routinely take shave
margins would resect. No one had evaluated the impact of further resection on operative time,
nor in a blinded fashion, evaluated cosmesis. Further, there had yet to be a prospective
study to evaluate the impact of this on local recurrence rates. Hence, the investigators
performed a prospective randomized controlled trial of this technique at Yale. The data from
this study, published in the New England Journal of Medicine, found that the technique cut
positive margin and re-excision rates in half. Some wondered, however, about the external
generalizability of these findings, particularly in non-academic settings. Hence, a
multicenter trial to validate these findings is warranted.

Inclusion Criteria

1. Breast cancer, stage 0-3, deemed a surgically appropriate candidate for partial
mastectomy with planned procedure for the same

2. Women ≥ 18 years of age

3. Ability to understand and the willingness to sign a written informed consent document.

Exlusion Criteria

1. Total mastectomy

2. Known metastatic disease

3. Bilateral synchronous breast cancer

4. Multicentric cancers requiring double lumpectomy

5. Previous history of breast cancer (even in the other breast)

6. Patients receiving Intraoperative radiation therapy (IORT)

7. Patients who had excisional biopsy for diagnosis of their cancer (I.e., instead of a
core biopsy)