Margin Assessment in Breast-Conserving Surgery: A Comparative Analysis of Frozen Section and Cavity Shave Techniques
In brief
Cavity shave margins cut surgery time by up to 18 minutes, re-excisions unchanged
In a review of 2,224 breast-conserving operations, cavity shave margins achieved the same 12% re-excision rate as intraoperative frozen section but shortened the procedure by about 18 minutes for lumpectomy alone and 5 minutes when sentinel node biopsy was added. The finding supports a faster, equally effective margin strategy, though prospective validation is still needed.
- Journal
- Annals of surgical oncology (Q1)
- Published
- 17 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Erin Kim, Ellen Chapel, Jasmine C Walker, Joseph Evans, Lesly A Dossett, Tasha M Hughes, et al.
- PMID
- 42753063
- DOI
- 10.1245/s10434-026-20417-6
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 20 September 2026): Margin Assessment in Breast-Conserving Surgery, FS vs CSM
Abstract
BACKGROUND: Margin status is a critical determinant of local recurrence after breast-conserving surgery (BCS). Achieving negative margins at the initial operation remains a key goal to optimize oncologic outcomes and minimize the need for additional surgery. Techniques to reduce positive margins include intraoperative frozen section (FS) analysis and cavity shave margins (CSMs). This study aimed to compare re-excision rates and operative times between these approaches. METHODS: A retrospective cohort study analyzed adults undergoing BCS with or without sentinel lymph node biopsy (SLNB) from January 2017 to February 2025. Margin assessment technique, clinicopathologic characteristics, re-excision for margin clearance, and operative time were collected. Cases using both FS and CSM were excluded. RESULTS: Among 2224 BCS cases, 1431 (64.4 %) used FS and 793 (35.7 %) used CSM. During 2017-2022, FS was more commonly used, but CSM utilization surpassed FS in 2023. Re-excision rates were similar between FS and CSM overall (12.8 % vs 12.1 %; p = 0.65) and across invasive histologic subtypes, multifocality, bilateral disease, and receipt of neoadjuvant chemotherapy (all p > 0.05). Stratification by procedure type showed that CSM reduced operative time compared with FS by approximately 18 min for BCS alone (53.5 ± 26.9 vs 71.2 ± 22.4 min; p <0.001) and by approximately 5 min for BCS with SLNB (72.8 ± 30.0 vs 77.8 ± 29.1 min; p = 0.005). CONCLUSIONS: After BCS, FS and CSM achieved comparable re-excision rates across histologic subtypes. The CSM technique was associated with significantly shorter operative times, supporting its use as an efficient margin assessment strategy.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.