Cavity Shave Margins in Breast Conservative Surgery a Strategy to Reduce Positive Margins and Surgical Time

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I would like to cheer the authors for their interesting study. Breast surgery field is in continuous eveolution and every contribution to this path is precious. Before recommending the current paper for publishing, I would like to ask someminor revisions:

1. English language needs revision by a native speaker as many tenses are too long and difficult to comprehend easily.

2 In Introduction, line 58: “The has a negative psychological affect...”. The must be changed into This.

3. In Introduction, line 63-64: eliminate “inizio modulo” and “fine modulo”.

4. In line 78: “Materialandmethods” need spaces between words.

5. In Materials and Methods, line 106-107: please describe better the surgical technique of the cavity shaving. Did the extra layer of removal involve all the sides of the cavity or just the side closest to tumor?

6. In Results, line 146-147: which was the criteria to select which procedure to apply to each patient? Was the cavity shaving procedure assigned randomly or was there some other criteria to select patients for CS-Group?

Comments on the Quality of English Language

English language needs revision by a native speaker as many tenses are too long and difficult to comprehend.

Author Response

I would like to cheer the authors for their interesting study. Breast surgery field is in continuous evolution and every contribution to this path is precious. Before recommending the current paper for publishing, I would like to ask some minor revisions:

1)English language needs revision by a native speaker as many tenses are too long and difficult to comprehend easily.

Thank you, we provide English revision by a native speaker. Moreover, Dr Sadri a surgeon in UK, performed a further revision.

2) In Introduction, line 58: “The has a negative psychological affect...”. The must be changed into This.

We provide to correct the mistake. Thank you.

3) In Introduction, line 63-64: eliminate “inizio modulo” and “fine modulo”

Done

4) In line 78: “Materialandmethods” need spaces between words.

We provide to add the space between the words. Thank you.

5) In Materials and Methods, line 106-107: please describe better the surgical technique of the cavity shaving. Did the extra layer of removal involve all the sides of the cavity or just the side closest to tumor?

With the cavity shave technique, the lesion is removed close to the tumor. After the first resection all margins are widen in order to clean the whole cavity from possible infiltrate. We provide to clarify also in the text are your suggestion.

6) In Results, line 146-147: which was the criteria to select which procedure to apply to each patient? Was the cavity shaving procedure assigned randomly or was there some other criteria to select patients for CS-Group?

As I added in the discussion this is a study limitation. Due to retrospective nature of the study the choosing of the technique was dependent by the surgeon and this study is limited to observe retrospectively data.

Reviewer 2 Report

Comments and Suggestions for Authors

Authors present an interesting article regarding cavity shave in BCS to reduce positive margins rate. I recommend to perform minor revisions. 

1. How is possible, that the surgical time was lower in patients with cavity shave, whilst this is an additional procedure? EDIT: I found the answer in the discussion section, but I recommend to write it to Methods and also to Abstract with closer description, how do you perform intraoperative margin evaluation (specimen x-ray?). 

2. Did you evaluate aesthetics outcomes in the study group? Some studies reported worse aesthetic outcome, because cavity shaving is associated with more tissue removal. 

3. There are multiple typing errors in the article. 

4. I recommend to desribe the method of cavity shaving in the Methods with more details (exact description of procedure, name of device). Also, how do you proceed in positive margins after cavity shaving - how did you evaluate, that cavity shaving was sufficient for negative margin achievement? 

5. Table 4 - there is typing error - 2 C-groups instead of CS and C. 

6. Limitations of the study are missing in the Discussion section. 

7. The number of references is suboptimal. 

Author Response

1)How is possible, that the surgical time was lower in patients with cavity shave, whilst this is an additional procedure? EDIT: I found the answer in the discussion section, but I recommend to write it to Methods and also to Abstract with closer description, how do you perform intraoperative margin evaluation (specimen x-ray?). 

Using the conventional surgical technique all surgical specimen is sent for an intraoperative histopathological analysis that macroscopically evaluates the tissue, even a microscopical study is performed based on the pathologist judgement. We provide to clarify also in the text are your suggestion.

2) Did you evaluate aesthetics outcomes in the study group? Some studies reported worse aesthetic outcome, because cavity shaving is associated with more tissue removal. 

No. Due to the retrospective nature of the study we have not this data. We provide to add this limitation in the discussion.

3) There are multiple typing errors in the article. 

Thank you we provide to correct.

4) I recommend to describe the method of cavity shaving in the Methods with more details (exact description of procedure, name of device). Also, how do you proceed in positive margins after cavity shaving - how did you evaluate, that cavity shaving was sufficient for negative margin achievement? 

We provide to clarify un the manuscript.

5) Table 4 - there is typing error - 2 C-groups instead of CS and C. 

Thank you we provide to correct the error.

6)  Limitations of the study are missing in the Discussion section.

 The main limitation of the study is the retrospective nature. In fact, as can be seen from the study, the choice of technique was entrusted to the surgeon's preference based on the type of lesion and probably also on experience. Furthermore, as this study is retrospective, it meant that we did not have data on the aesthetic outcome. This retrospective work of ours lays the foundations and identifies the fundamental parameters for designing a new prospective randomized study to compare the two techniques.

7. The number of references is suboptimal. 

Thanks to suggestions. We expand the discussion and add references