Gundersen Medical Foundation, La Crosse, WI, USA.
Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2019 May;26(5):1238-1244. doi: 10.1245/s10434-019-07247-5. Epub 2019 Feb 21.
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 < 0.0001).
The findings of a 35% reduction in the odds of re-excision after the guideline publication and a reduction in re-excision prevalence from 22 to 14% supports the notion that the SSO-ASTRO margin guideline was impactful. These findings are congruent with the projected reductions in re-excision at the time of guideline publication.
五分之一接受初始保乳切除术治疗浸润性乳腺癌的患者随后需要再次进行切除术或乳房切除术。由于保乳术切缘宽度导致再次切除的时机不明确，导致这种高再手术率。我们旨在确定外科肿瘤学会（SSO）和美国放射肿瘤学会（ASTRO）切缘指南对保乳术后再手术率的影响。该指南建议在标本中“无肿瘤墨水”时不常规进行再次切除。
进行了系统的文献回顾。对于符合条件的研究，在 SSO-ASTRO 切缘指南发表前后，使用随机效应模型对保乳切除术再次切除的流行率进行了荟萃分析。通过 Cochran's Q 检验测量研究异质性。
符合纳入标准的有 5 项机构研究、1 项基于人群的研究和 1 项国家注册研究。每项研究的样本量从 237 例到 26102 例不等。研究间存在显著的异质性（Q = 19.779；p = 0.003）。指南发布前的再次切除流行率为 22%（置信区间 [CI] 20-23），发布后为 14%（CI 12-15）。以指南发布前的再次切除流行率为参考值，指南发布后的再次切除比值比为 0.65（CI 0.54-0.78；p<0.0001）。
指南发布后再次切除的可能性降低了 35%，再切除流行率从 22%降至 14%，这支持了 SSO-ASTRO 切缘指南具有影响力的观点。这些发现与指南发布时预计的再次切除减少量一致。
