Impact of routine cavity shave margins on breast cancer re-excision rates.

PURPOSE: Breast-conserving therapy (BCT) is an accepted method of treating early breast cancer. We hypothesized that routine excision of additional cavity shave margins (CSM) at time of initial partial mastectomy reduces the need for additional surgery. METHODS: A single-institution retrospective review was performed of women, 18 years or older, with a new diagnosis of breast cancer who underwent partial mastectomy between 1 January 2004 and 1 October 2009. Five hundred thirty-three charts were reviewed. Of those, 69 patients underwent CSM at time of initial operation. These 69 patients were matched with patients who had undergone partial mastectomy without CSM by tumor size, presence of extensive intraductal component, and primary histology. RESULTS: The two groups were well matched for age, nuclear grade, associated lymphovascular invasion (LVI), receptor status, and multifocality. We found that 31.9% (44/138) required return to the operating room (OR) for re-excision of margins. Rate of return to the OR was 21.7% (15/69) in the CSM group and 42.0% (29/69) in the matched group (p = 0.011). Multivariate analysis found factors significantly associated with need for additional operation included lack of CSM (odds ratio 9.2, 95% CI 2.8-30.5, p = 0.0003), larger extent of intraductal component (odds ratio 7.0, 95% CI 1.8-27.0, p = 0.005), and lack of directed re-excision (odds ratio 6.4, 95% CI 1.7-25.1, p = 0.007). CONCLUSIONS: CSM at time of initial partial mastectomy decreases rate of re-excision by as much as ninefold. CSM should be considered at time of initial operation to reduce the need for subsequent reoperation.

Unusual presentation of ovarian cellular fibroma coexisting with nodular sclerosing Hodgkin's disease: a case report and review of the literature.

A case of a nonfunctioning, noncalcified ovarian cellular fibroma in a 15-year-old adolescent girl is described. The fibroma was found incidentally in a patient who was later found to have nodular sclerosing Hodgkin's disease. The patient presented with symptoms suggestive of lymphoma but on exam was found to have a mobile and nontender abdominal mass. Laparotomy exposed a smooth, well-circumscribed left ovarian mass. A left salpingoophorectomy was performed. The mass weighed 2390 g and measured 19 x 15 x 8.5 cm. Approximately 15% of the tumor was composed of large cellular nodules identified as spindle cells having a storiform pattern. Mild nuclear atypia with 2 mitosis per 10 high-power fields was noted. An ovarian fibroma in a 15-year-old is an unexpected diagnosis. Less than 1% of ovarian stromal tumors are found in patients 19 years and younger. The uncommon histology and additional classification as a cellular fibroma as well as the simultaneous diagnosis of 2 neoplasms in this case are remarkable.