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Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis

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Title: Diagnostic accuracy of intraoperative techniques for margin assessment in breast cancer surgery: a meta-analysis
Authors: St John, ER
Al-Khudairi, R
Ashrafian, H
Athanasiou, T
Takats, Z
Hadjiminas, DJ
Darzi, A
Leff, DR
Item Type: Journal Article
Abstract: OBJECTIVE: The aim of this study was to conduct a systematic review and meta-analysis to clarify the diagnostic accuracy of intraoperative breast margin assessment (IMA) techniques against which the performance of emerging IMA technologies may be compared. SUMMARY OF BACKGROUND DATA: IMA techniques have failed to penetrate routine practice due to limitations, including slow reporting times, technical demands, and logistics. Emerging IMA technologies are being developed to reduce positive margin and re-excision rates and will be compared with the diagnostic accuracy of existing techniques. METHOD: Studies were identified using electronic bibliographic searches up to January 2016. MESH terms and all-field search terms included "Breast Cancer" AND "Intraoperative" AND "Margin." Only clinical studies with raw diagnostic accuracy data as compared with final permanent section histopathology were included. A bivariate model for diagnostic meta-analysis was used to attain overall pooled sensitivity and specificity. RESULTS: Eight hundred thirty-eight unique studies revealed 35 studies for meta-analysis. Pooled sensitivity (Sens), specificity (Spec), and area under the receiver operating characteristic curve (AUROC) values were calculated per group (Sens, Spec, AUROC): frozen section = 86%, 96%, 0.96 (n = 9); cytology = 91%, 95%, 0.98 (n = 11); intraoperative ultrasound = 59%, 81%, 0.78 (n = 4); specimen radiography = 53%, 84%, 0.73 (n = 9); optical spectroscopy = 85%, 87%, 0.88 (n = 3). CONCLUSIONS: Pooled data suggest that frozen section and cytology have the greatest diagnostic accuracy. However, these methods are resource intensive and turnaround times for results have prevented widespread international adoption. Emerging technologies need to compete with the diagnostic accuracy of existing techniques while offering advantages in terms of speed, cost, and reliability.
Issue Date: 15-Jul-2016
Date of Acceptance: 1-Jul-2016
URI: http://hdl.handle.net/10044/1/38410
DOI: https://dx.doi.org/10.1097/SLA.0000000000001897
ISSN: 1528-1140
Publisher: Wolters Kluwer Health
Start Page: 300
End Page: 310
Journal / Book Title: Annals of Surgery
Volume: 265
Issue: 2
Copyright Statement: © 2016 Wolters Kluwer Health, Inc. All rights reserved. This is the accepted version of an article published in final form at http://dx.doi.org/10.1097/SLA.0000000000001897.
Sponsor/Funder: National Institute for Health Research
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Micromass UK Ltd
Funder's Grant Number: NF-SI-0510-10186
RDB04 79560
RD207
ICL 01/02/03
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
breast
breast-conserving surgery
cancer
clear edge
cytology
diagnostic accuracy
frozen section
intraoperative margin assessment
intraoperative ultrasound
MarginProbe
margins
mass spectrometry
meta-analysis
optical spectroscopy
Raman spectroscopy
rapid evaporative ionization mass spectrometry
specimen radiography
surgery
systematic review
FROZEN-SECTION ANALYSIS
TOUCH PREPARATION CYTOLOGY
CONSERVING SURGERY
RE-EXCISION
SURGICAL MARGINS
SPECIMEN RADIOGRAPHY
CONSERVATION SURGERY
LUMPECTOMY MARGINS
IMPRINT CYTOLOGY
HISTOLOGIC CORRELATION
Breast Neoplasms
Female
Humans
Intraoperative Care
Margins of Excision
Mastectomy
Models, Statistical
11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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