Rationale and objectives
Achieving adequate resection margins in breast conserving surgery is challenging and
often demands more than one surgical procedure. We evaluated pooled diagnostic sensitivity,
and specificity of radiological methods for intraoperative margin assessment and their
impact on repeat surgery rate.
Materials and methods
We included studies using radiography, digital breast tomosynthesis (DBT), micro-CT,
and ultrasound for intraoperative margin assessment with the histological assessment
as the reference method. A systematic search was performed in PubMed, Embase, Cochrane
Library, Scopus, and Web of Science. Two investigators screened the studies for eligibility
criteria and extracted data of the included studies independently. The quality assessment
on diagnostic accuracy studies (QUADAS)-2 tool was used. A bivariate random effect
model was used to obtained pooled sensitivity and specificity of the index tests in
the meta-analysis.
Results
The systematic search resulted in screening of 798 unique records. Twenty-two articles
with 29 radiological imaging methods were selected for meta-analysis. Pooled sensitivity
and specificity and area under the curve were calculated for each of the 4 subgroups
in the meta-analysis respectively: Radiography; 52%, 77%, 60%, DBT; 67%, 76%, 76%,
micro-CT; 68%, 69%, 72%, and ultrasound; 72%, 78%, 80%. The repeat surgery rate was
poorly reported in the included studies.
Conclusion
Ultrasound showed the highest and radiography the lowest diagnostic performance for
intraoperative margin assessment. However, the heterogeneity between studies was high
and the subgroups small. The radiological methods for margin assessment need further
improvement to provide reliable guidance in the clinical workflow and to prevent repeat
surgeries.
Key Words
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Article info
Publication history
Published online: January 04, 2022
Accepted:
December 6,
2021
Received in revised form:
November 29,
2021
Received:
October 8,
2021
Identification
Copyright
© 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
