Margin positivity and re-excision after breast-conserving surgery following neoadjuvant chemotherapy: A systematic review and meta-analysis.
Niamh Keating, Tim Harding, Jane Rothwell et al.
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In 30 seconds
This systematic review and random-effects meta-analysis examined tumour-on-ink margin positivity and re-excision after breast-conserving surgery (BCS) following neoadjuvant chemotherapy (NACT). Seven retrospective cohort studies included 3962 patients; six studies with 3855 patients contributed to quantitative synthesis. The pooled margin positivity rate after index BCS was 9.7% (95% CI 5.8-13.6%), and the pooled re-excision rate was 14.0% (95% CI 0.0-30.6%). Re-excision estimates varied substantially between studies. Residual ductal carcinoma in situ and invasive lobular carcinoma were most consistently associated with higher rates of margin positivity and re-excision.
Key findings
- Pooled tumour-on-ink margin positivity after index BCS following NACT was 9.7% (95% CI 5.8-13.6%).
- The pooled re-excision rate was 14.0% (95% CI 0.0-30.6%), with substantial between-study heterogeneity.
- Residual DCIS and invasive lobular carcinoma were most consistently associated with higher margin positivity and re-excision.
Why it matters
These pooled estimates help characterise the likelihood of involved margins and further surgery after BCS following NACT. The marked variation in re-excision rates suggests that observed outcomes may depend partly on institutional practice and thresholds for reoperation. The associations with residual DCIS and invasive lobular carcinoma highlight features that may be relevant to surgical planning and counselling, while not establishing individual risk.
What to keep in mind
The evidence came from retrospective cohorts, and re-excision estimates showed substantial between-study heterogeneity.