Impact of the SSO-ASTRO Margin Guideline on Rates of Re-excision After Lumpectomy for Breast Cancer: A Meta-analysis
| Autor: | Monica Morrow, Luis D. Ramirez, Liska Havel, Jeffrey Landercasper, Himani Naik |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Reoperation
medicine.medical_specialty medicine.medical_treatment Breast Neoplasms 03 medical and health sciences 0302 clinical medicine Breast cancer Medicine Humans Practice Patterns Physicians' Radiation oncologist Mastectomy business.industry General surgery Lumpectomy Radiation Oncologists Margins of Excision Odds ratio Guideline medicine.disease United States Study heterogeneity Surgical Oncology Oncology 030220 oncology & carcinogenesis Meta-analysis Practice Guidelines as Topic 030211 gastroenterology & hepatology Surgery Female Guideline Adherence business |
| Zdroj: | Annals of surgical oncology. 26(5) |
| ISSN: | 1534-4681 |
| Popis: | One in five patients undergoing initial lumpectomy for invasive breast cancer subsequently undergoes re-excision or mastectomy. A lack of clarity of when to re-excise based on lumpectomy margin width contributes to this high rate of reoperation. We sought to determine the impact of the Society of Surgical Oncology (SSO) and American Society of Radiation Oncologist (ASTRO) margin guideline on reoperation rates after lumpectomy. The guideline recommended omission of routine re-excision in specimens with “no ink on tumor”. A systematic literature review was performed. For eligible studies, a random-effects model was used for a meta-analysis of lumpectomy re-excision prevalence before and after publication of the SSO-ASTRO margin guideline. Study heterogeneity was measured by the Cochran’s Q test. Five institutional, one population-based, and one national registry study met inclusion requirements. Sample size per study ranged from 237 to 26,102. There was significant interstudy heterogeneity (Q = 19.779; p = 0.003). Pooled re-excision prevalence was 22% (confidence interval [CI] 20–23) before and 14% (CI 12–15) after guideline publication. With the pre-guideline re-excision prevalence used as the reference value, the associated odds ratio for re-excision after the guideline was 0.65 (CI 0.54–0.78; p |
| Databáze: | OpenAIRE |
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