Geographic and Temporal Trends in the Management of Occult Primary Breast Cancer: A Systematic Review and Meta-Analysis View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2013-08-22

AUTHORS

Oluwadamilola M. Fayanju, Carolyn R. T. Stoll, Susan Fowler, Graham A. Colditz, Donna B. Jeffe, Julie A. Margenthaler

ABSTRACT

Background Management of occult primary breast cancer (OPBC), including the role of magnetic resonance imaging (MRI), is controversial. We conducted a pooled analysis of OPBC patients and a meta-analysis of MRI accuracy in OPBC in order to elucidate current practices.MethodsA literature search yielded 201 studies. Patient-level data for clinically/mammographically OPBC from studies published after 1993 and from our institution were pooled; logistic regression examined associations between patient/study data and outcomes, including treatments and recurrence. We report adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI) significant at 2-tailed p < 0.05. Meta-analysis included data for patients who received MRIs for workup of clinically/mammographically OPBC. We report pooled sensitivity and specificity with 95 % CIs.ResultsThe pooled analysis included 92 patients (15 studies [n = 85] plus our institution [n = 7]). Patients from Asia were more likely to receive breast surgery (OR = 5.98, 95 % CI = 2.02–17.65) but not chemotherapy (OR = 0.32, 95 % CI = 0.13–0.82); patients from the United States were more likely to receive chemotherapy (OR = 13.08, 95 % CI = 2.64–64.78). Patients from studies published after 2003 were more likely to receive radiotherapy (OR = 3.86, 95 % CI = 1.41–10.55). Chemotherapy recipients were more likely to have distant recurrence (OR = 9.77, 95 % CI = 1.10–87.21). More patients with positive MRIs received chemotherapy than patients with negative MRIs (10 of 12 [83.3 %] vs 5 of 13 [38.5 %]; p = 0.0414). In the MRI-accuracy meta-analysis (10 studies, n = 262), pooled sensitivity and specificity were 96 % (95 % CI = 91–98 %) and 63 % (95 % CI = 42–81 %), respectively.ConclusionsOPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards. More... »

PAGES

3308-3316

References to SciGraph publications

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  • 2003-10. Occult breast carcinoma presenting with axillary lymph node metastases: follow-up of eleven patients in BREAST CANCER
  • 2006-05-18. Ethnic Disparities in Breast Cancer Management Among Asian Americans and Pacific Islanders in ANNALS OF SURGICAL ONCOLOGY
  • 2001-04. Occult breast cancer and axillary mass in CURRENT TREATMENT OPTIONS IN ONCOLOGY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1245/s10434-013-3157-5

    DOI

    http://dx.doi.org/10.1245/s10434-013-3157-5

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    27 schema:description Background Management of occult primary breast cancer (OPBC), including the role of magnetic resonance imaging (MRI), is controversial. We conducted a pooled analysis of OPBC patients and a meta-analysis of MRI accuracy in OPBC in order to elucidate current practices.MethodsA literature search yielded 201 studies. Patient-level data for clinically/mammographically OPBC from studies published after 1993 and from our institution were pooled; logistic regression examined associations between patient/study data and outcomes, including treatments and recurrence. We report adjusted odds ratios (OR) and 95 % confidence intervals (95 % CI) significant at 2-tailed p < 0.05. Meta-analysis included data for patients who received MRIs for workup of clinically/mammographically OPBC. We report pooled sensitivity and specificity with 95 % CIs.ResultsThe pooled analysis included 92 patients (15 studies [n = 85] plus our institution [n = 7]). Patients from Asia were more likely to receive breast surgery (OR = 5.98, 95 % CI = 2.02–17.65) but not chemotherapy (OR = 0.32, 95 % CI = 0.13–0.82); patients from the United States were more likely to receive chemotherapy (OR = 13.08, 95 % CI = 2.64–64.78). Patients from studies published after 2003 were more likely to receive radiotherapy (OR = 3.86, 95 % CI = 1.41–10.55). Chemotherapy recipients were more likely to have distant recurrence (OR = 9.77, 95 % CI = 1.10–87.21). More patients with positive MRIs received chemotherapy than patients with negative MRIs (10 of 12 [83.3 %] vs 5 of 13 [38.5 %]; p = 0.0414). In the MRI-accuracy meta-analysis (10 studies, n = 262), pooled sensitivity and specificity were 96 % (95 % CI = 91–98 %) and 63 % (95 % CI = 42–81 %), respectively.ConclusionsOPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards.
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    35 ConclusionsOPBC management
    36 MRI accuracy
    37 Meta-Analysis
    38 MethodsA literature search
    39 OPBC patient registry
    40 OPBC patients
    41 Patient Registry
    42 United States
    43 accuracy
    44 analysis
    45 association
    46 background
    47 breast cancer
    48 breast surgery
    49 cancer
    50 chemotherapy
    51 chemotherapy recipients
    52 cis
    53 confidence intervals
    54 current practice
    55 data
    56 distant recurrence
    57 global treatment standards
    58 imaging
    59 institutions
    60 international OPBC patient registry
    61 intervals
    62 literature search
    63 logistic regression
    64 longitudinal study
    65 magnetic resonance imaging
    66 management
    67 more patients
    68 negative magnetic resonance imaging
    69 occult primary breast cancer
    70 odds ratio
    71 order
    72 outcomes
    73 patient-level data
    74 patient/study data
    75 patients
    76 pooled analysis
    77 pooled sensitivity
    78 positive magnetic resonance imaging
    79 practice
    80 primary breast cancer
    81 radiotherapy
    82 ratio
    83 recipients
    84 recurrence
    85 registry
    86 regression
    87 resonance imaging
    88 review
    89 role
    90 search
    91 sensitivity
    92 specificity
    93 standards
    94 state
    95 study
    96 study data
    97 surgery
    98 systematic review
    99 temporal trends
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