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

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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.

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Author information

Authors and Affiliations

  1. Department of General Surgery, All India Institute of Medical Sciences, Patna, India

    Chandan Kumar Jha & Prashant Kumar Singh

  2. Wythenshawe Hospital and Nightingale Breast Center, Manchester University Foundation Trust, Raebareli, India

    Goonj Johri

  3. Department of General Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, India

    Sanjay Kumar Yadav

  4. Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, India

    Upasna Sinha

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  1. Chandan Kumar Jha
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  4. Sanjay Kumar Yadav
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Contributions

CKJ: conceptualization, literature search, screening of the selected articles, data collection and analysis, drafting of the manuscript. GJ: literature search, screening of the selected articles, data collection, and drafting of the manuscript. SKY and US: conceptualization, screening of the selected articles, and revision of the manuscript. PKS: conceptualization, literature search, screening of the selected articles, and supervision of the study.

Corresponding author

Correspondence to Chandan Kumar Jha.

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Ethics Approval

This systematic review was carried out after registering the protocol for a systematic review with International Prospective Register of Systematic Reviews, PROSPERO (ID-CRD42020165806). The PRISMA 2009 guidelines were followed throughout this review.

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All authors approved the manuscript and gave consent for publication.

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The authors declare no competing interests.

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Appendix

Appendix

Search Strategy for PubMed

breast AND (cancer OR carcinoma OR neoplasm OR lesion) AND (mapping OR marking OR localisation OR localization OR “tissue marker clip” OR “tissue marker” OR clip OR marker OR “skin tattoo” OR tattoo OR ROLL OR ROSL OR WGL OR “wire guided” OR “needle wire” OR magseed OR hydrogel OR hydromark OR “radioactive seed” OR “radioactive” OR “seed” OR saviscout OR saviSCOUT) AND (“neoadjuvant chemotherapy” OR “neoadjuvant systemic therapy” OR “preoperative chemotherapy” OR “preoperative systemic therapy” OR “induction chemotherapy” OR “anterior chemotherapy” OR “neo-adjuvant chemotherapy” OR “neo-adjuvant systemic therapy”)

Search Strategy for Cochrane

breast in Title Abstract Keyword AND cancer OR carcinoma OR neoplasm OR lesion in Title Abstract Keyword AND mapping OR marking OR localisation OR localization OR “tissue marker clip” OR “tissue marker” OR clip OR marker OR “skin tattoo” OR tattoo OR ROLL OR ROSL OR WGL OR “wire guided” OR “needle wire” OR magseed OR hydrogel OR hydromark OR “radioactive seed” OR “radioactive” OR “seed” OR saviscout OR saviSCOUT in Title Abstract Keyword AND “neoadjuvant chemotherapy” OR “neoadjuvant systemic therapy” OR “preoperative chemotherapy” OR “preoperative systemic therapy” OR “induction chemotherapy” OR “anterior chemotherapy” OR “neo-adjuvant chemotherapy” OR “neo-adjuvant systemic therapy” in Title Abstract Keyword with Cochrane Library publication date to Sep 2020, in Trials with 'Breast Cancer' in Cochrane Groups (Word variations have been searched)

Search Strategy for Embase

(((exp BREAST/ OR (breast).ti,ab) AND (exp NEOPLASM/ OR exp "INVASIVE CARCINOMA"/ OR (carcinoma).ti,ab OR exp NEOPLASM/ OR (neoplasm).ti,ab)) AND ((localisation).ti,ab OR (localization).ti,ab OR (mapping).ti,ab OR (marking).ti,ab OR (tumour marking).ti,ab OR (tissue marking).ti,ab OR (tissue marking clip).ti,ab OR (clip).ti,ab OR (marker).ti,ab OR (skin tattoo).ti,ab OR (ROLL).ti,ab OR (ROSL).ti,ab OR (WGL).ti,ab OR (Wire guided).ti,ab OR (needle wire).ti,ab OR (magseed).ti,ab OR (hydrogel).ti,ab OR (radioactive seed).ti,ab OR (saviscout).ti,ab)) AND ((neoadjuvant chemotherapy).ti,ab OR (neoadjuvant systemic therapy).ti,ab OR (preoperative systemic therapy).ti,ab OR (preoperative chemotherapy).ti,ab OR (induction chemotherapy).ti,ab OR (anterior chemotherapy).ti,ab OR (neo- adjuvant systemic therapy).ti,ab OR (neo-adjuvant chemotherapy).ti,ab)

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Jha, C.K., Johri, G., Singh, P.K. et al. Does Tumor Marking Before Neoadjuvant Chemotherapy Helps Achieve Better Outcomes in Patients Undergoing Breast Conservative Surgery? A Systematic Review . Indian J Surg Oncol 12, 624–631 (2021). https://doi.org/10.1007/s13193-021-01393-7

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