Optimal localization strategies for non-palpable breast cancers -A network meta-analysis of randomized controlled trials

Matthew G Davey; John P M O'Donnell; Michael R Boland; Éanna J Ryan; Stewart R Walsh; Michael J Kerin; Aoife J Lowery

doi:10.1016/j.breast.2022.02.004

Optimal localization strategies for non-palpable breast cancers -A network meta-analysis of randomized controlled trials

Breast. 2022 Apr:62:103-113. doi: 10.1016/j.breast.2022.02.004. Epub 2022 Feb 8.

Authors

Matthew G Davey¹, John P M O'Donnell², Michael R Boland², Éanna J Ryan², Stewart R Walsh², Michael J Kerin², Aoife J Lowery²

Affiliations

¹ Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland. Electronic address: m.davey7@nuigalway.ie.
² Department of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway, H91 YR71, Ireland.

Abstract

Purpose: Mammographic screening programmes have increased detection rates of non-palpable breast cancers. In these cases, wire-guided localization (WGL) is the most common approach used to guide breast conserving surgery (BCS). Several RCTs have compared WGL to a range of novel localization techniques. We aimed to perform a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing methods of non-palpable breast cancer localization.

Methods: A NMA was performed according to PRISMA-NMA guidelines. Analysis was performed using R packages and Shiny.

Results: 24 RCTs assessing 9 tumour localization methods in 4236 breasts were included. Margin positivity and reoperation rates were 16.9% (714/4236) and 14.3% (409/2870) respectively. Cryo-assisted localization had the highest margin positivity (28.2%, 58/206) and reoperation (18.9%, 39/206) rates. Compared to WGL (n = 2045 from 24 RCTs) only ultrasound guided localization (USGL) (n = 316 from 3 RCTs) significantly lowered margin positivity (odds ratio (OR): 0.192, 95% confidence interval (CI): 0.079-0.450) and reoperation rates (OR: 0.182, 95%CI: 0.069-0.434). Anchor-guided localization (n = 52, 1 RCT) significantly lowered margin positivity (OR: 0.229, 95%CI: 0.050-0.938) and magnetic-marker localization improved patient satisfaction (OR: 0.021, 95%CI: 0.001-0.548). There was no difference in operation duration, overall complications, haematoma, seroma, surgical site infection rates, or specimen size/vol/wt between methods.

Conclusion: USGL and AGL are non-inferior to WGL for the localization of non-palpable breast cancers. The reported data suggests that these techniques confer reduced margin positivity rates and requirement for re-operation. However, caution when interpreting results relating to RCTs with small sample sizes and further validation is required in larger prospective, randomized studies.

Keywords: Breast cancer; Localization; Precision oncology; Targeted surgery.

Publication types

Review

MeSH terms

Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Female
Humans
Margins of Excision
Mastectomy, Segmental / methods
Network Meta-Analysis
Randomized Controlled Trials as Topic