While positive margins on lumpectomy specimens have long been associated with an increased risk of breast tumor recurrence, the specifics regarding optimal margins have remained unclear.

In this study, researchers analyzed data from 98 patients who underwent re-excision surgery at Montefiore Einstein Comprehensive Cancer Center. They identified a significant correlation between nipple-ward margin and the subsequent need for re-excision. “Our study shows that the nipple-ward margin is most often the culprit,” says Dr. Feldman.

Of the samples in which positive margins were identified, a striking 48% were in the nipple-ward direction. Furthermore, among cases with single-margin positivity, an overwhelming 57.8% were in the nipple-ward direction.

The findings underscore the importance of a surgical team’s orientation during lumpectomy procedures. Dr. Feldman proposes a simple technique modification that involves “planning a lumpectomy procedure with a more elliptical rather than spherical resection, and with additional cavity shave in the nipple-ward direction.”

He suggests that adopting this approach, which involves an additional shave during the initial lumpectomy, could significantly reduce re-excision rates. The potential impact is substantial, he emphasizes, noting that “this simple alteration may minimize patient discomfort, expense, and preserve breast appearance.”

While these findings are promising, Dr. Feldman highlights the need for further research to validate them. “Future studies with larger sample sizes are required to bolster our findings,” he says. “We are now planning a prospective study to potentially show a reduction in margin issues when we alter the orientation of the lumpectomy in the nipple-ward direction.”

This groundbreaking research not only sheds light on a previously overlooked aspect of lumpectomy surgeries but paves the way for more effective strategies in global efforts to reduce breast cancer recurrence.