by Matthew G. Davey, John P.M. O'Donnell, Michael R. Boland,
Éanna J. Ryan, Stewart R. Walsh, Michael J. Kerin, Aoife J. Lowery
The Breast: Published:February 07, 2022
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.
