Impact of the SSO-ASTRO Margin Guideline on Rates of Re-excision After Lumpectomy for Breast Cancer: A Meta-analysis

Annals of Surgical Oncology
Liska HavelJeffrey Landercasper

Abstract

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 odd...Continue Reading

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Citations

May 23, 2020·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Stuart J SchnittArmando E Giuliano
Sep 5, 2019·Annals of Surgical Oncology·Edibaldo Silva, Mona Tan
Jun 12, 2020·Annals of Surgical Oncology·Francesca Tamburelli, Riccardo Ponzone
Feb 25, 2019·Annals of Surgical Oncology·Anees B Chagpar
Aug 10, 2020·International Journal of Radiation Oncology, Biology, Physics·Martin C TomFrank Vicini
Feb 4, 2021·JAMA Surgery·Ton WangLesly A Dossett
Dec 17, 2019·The Breast : Official Journal of the European Society of Mastology·Giacomo MontagnaWalter P Weber
Nov 24, 2020·Annals of Surgical Oncology·Nina TamirisaMariana Chavez-MacGregor
May 23, 2020·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Riccardo Ponzone
Jul 19, 2021·Surgical Oncology·Miguel Mansilla-PoloAntonio Piñero-Madrona
Jul 26, 2021·Annals of Surgical Oncology·Ava ArmaniSarah Blair
Aug 2, 2021·Annals of Surgical Oncology·Swati A KulkarniXiao Han

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