Paula Clarke, Eduardo Carvalho Pessoa, Bertha Andrade Coelho, Daniel de Araújo Brito Buttros, Aleida Nazareth Soares, Bruna Torres Silvestre da Silva, Hélio Rubens de Carvalho Nunes, Carla Priscila Kamiya Carvalho Pessoa, Amanda Cristina Braga de Oliveira, Tereza Cristina de Oliveira Ferreira, Bernardo Ferreira de Paula Ricardo, Paola Hartung Toppa, André Mattar, Marcelo Antonini, Heverton Leal Ernesto de Amorim, Gustavo Machado Badan, Ruffo de Freitas Júnior, Marcus Nascimento Borges, Katyane Larissa Alves, Douglas de Miranda Pires, Shirley das Graças Ferreira, Gabriel de Almeida Silva Júnior, Romana Giordani Ribeiro Saliba, Ana Carolina Guglielmelli Mendonça, Larissa Barbosa Oliveira, Thais Paiva Moraes, Cristina Milene Barbosa Maynart Aragão, Felipe Marcondes de Oliveira Coelho, Letícia Martins de Araújo Campos Linhares, Heloisa Maria De Luca Vespoli, Annamaria Massahud Rodrigues Dos Santos, Mayne Cardoso Cani, Henrique Lima Couto
Cavity margins sample shaving is a potential approach to predict small breast cancer excision and should be added to vacuum-assisted excision in prospective trials. For DCIS, EVAB-CMSH should not be standard of care.
BACKGROUND: Excision of small breast cancers has been reported by vacuum-assisted biopsy (VAB). Nevertheless, patients are submitted to surgery, because there is no way to predict excision. The purpose of this study was to evaluate extended vacuum-assisted biopsy (EVAB) associated with cavity margins sample shaving (CMSH) to predict breast cancer excision.
METHODS: This is a retrospective database analysis of 120 cancers [both invasive breast cancers (IC) and ductal carcinoma in situ (DCIS)] diagnosed by EVAB-CMSH submitted to surgery with histological data from EVAB-CMSH and surgery. The CMSH was evaluated as a diagnostic test for excision compared to surgery as gold standard. Factors associated with residual tumor, gross residual tumor (GRD) (> 3 mm), and false-negative CMSH after EVAB-CMSH were evaluated.
RESULTS: A total of 120 cases were analyzed. Media age was 57 (48.5-69); image tumor size (T) was 11 (8.6-15) mm; pathological tumor size (pT) was 6 (4-10) mm; most cases IC+DCIS 53 (44.2%), DCIS 46 (38.3%), and IC 15 (12.5%); 45 (37.5%) were excised by EVAB-CMSH. CMSH sensitivity 70.7%, specificity 66.7%, false-negative rate 18.33%, and accuracy 69.2%. In multivariate analysis, DCIS pT (p = 0.003, odds ratio [OR] 1.46, 95% confidence interval [CI]) was associated with residual tumor; DCIS pT (p = 0.001, OR 1.34, 95% CI) and the CMSH T (p = 0.001, OR 1.67, 95% CI) with GRD; surgical specimen DCIS T (p = 0.015, OR 1.12, 95% CI) with CMSH false negative.
CONCLUSIONS: Cavity margins sample shaving is a potential approach to predict small breast cancer excision and should be added to vacuum-assisted excision in prospective trials. For DCIS, EVAB-CMSH should not be standard of care.