Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Sep;12(3):624-631.
doi: 10.1007/s13193-021-01393-7. Epub 2021 Aug 3.

Does Tumor Marking Before Neoadjuvant Chemotherapy Helps Achieve Better Outcomes in Patients Undergoing Breast Conservative Surgery? A Systematic Review

Chandan Kumar Jha  1 , Goonj Johri  2 , Prashant Kumar Singh  1 , Sanjay Kumar Yadav  3 , Upasna Sinha  4
Affiliations
Review

Does Tumor Marking Before Neoadjuvant Chemotherapy Helps Achieve Better Outcomes in Patients Undergoing Breast Conservative Surgery? A Systematic Review

Chandan Kumar Jha et al. Indian J Surg Oncol. 2021 Sep.

Abstract

Patients with breast cancer are increasingly being offered breast conserving surgery (BCS) following neoadjuvant chemotherapy (NACT). We aimed to conduct a systematic review to assess the advantage of tumor marking in patients undergoing BCS after NACT. After registering the protocol for a systematic review with PROSPERO, a systematic search was conducted through September 30, 2020, for all studies involving patients undergoing BCS post NACT after tumor marking. Margin status on final histology was the primary outcome. Oxford Centre for Evidence Based Medicine (OCEBM) levels were used to assess internal validity. A total of 636 records from Medline/PubMed, 1381 from Embase, and 1422 from Cochrane library were extracted. After screening, 15 articles (1520 patients) were included for data synthesis. For marking, 6 studies used metallic markers and 5 used 125I-radioactive seeds (RSL) followed by skin tattoo and radio-guided occult lesion localization using 99mTc (ROLL) in one study each. Most studies used a single marker at the center except for two (143 patients), who practiced the bracketing technique. Incidence of unsatisfactory margins (positive/close) ranged from 5 to 23.5%. After excluding patients with complete pathological response, the "adjusted unsatisfactory margin" rate was found to be 19.3% (10.4-33%). Overall 20.6 recurrences (locoregional/distant) were reported per 1000 patient-years follow-up. Overall survival (OS) was only reported by one study as 96.6% and 84.7% in patients with and without marker placement (p = .01). Re-excision and secondary mastectomy rates (reported by nine studies) were 7.3% and 5.7% respectively. There is limited evidence that tumor marking before neoadjuvant chemotherapy improves the rate of unsatisfactory margins or survival outcomes in a patient undergoing BCS after NACT.

Keywords: Breast cancer; Breast conservative surgery; Neoadjuvant chemotherapy; Positive margin; Tumor marking; Unsatisfactory margin.

PubMed Disclaimer

Conflict of interest statement

Conflict of InterestThe authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA 2009 flow diagram
See this image and copyright information in PMC

References

    1. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188–94. doi: 10.1093/jnci/dji021. - DOI - PubMed
    1. Butler-Henderson K, Lee AH, Price RI, Waring K. Intraoperative assessment of margins in breast conserving therapy: a systematic review. Breast. 2014;23(2):112–9. doi: 10.1016/j.breast.2014.01.002. - DOI - PubMed
    1. McCahill LE, Single RM, Aiello Bowles EJ, Feigelson HS, James TA, Barney T, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467–75. doi: 10.1001/jama.2012.43. - DOI - PubMed
    1. Heelan Gladden AA, Sams S, Gleisner A, Finlayson C, Kounalakis N, Hosokawa P, et al. Re-excision rates after breast conserving surgery following the 2014 SSO-ASTRO guidelines. Am J Surg. 2017;214(6):1104–1109. doi: 10.1016/j.amjsurg.2017.08.023. - DOI - PubMed
    1. Hill-Kayser CE, Vachani C, Hampshire MK, Di Lullo GA, Metz JM. Cosmetic outcomes and complications reported by patients having undergone breast-conserving treatment. Int J Radiat Oncol Biol Phys. 2012;83(3):839–44. doi: 10.1016/j.ijrobp.2011.08.013. - DOI - PubMed

LinkOut - more resources