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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 10/2013

01-10-2013 | Breast Oncology

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

Authors: Oluwadamilola M. Fayanju, MD, MPHS, Carolyn R. T. Stoll, MPH, MSW, Susan Fowler, MLIS, Graham A. Colditz, MD, DrPH, Donna B. Jeffe, PhD, Julie A. Margenthaler, MD

Published in: Annals of Surgical Oncology | Issue 10/2013

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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.

Methods

A 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.

Results

The 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.

Conclusions

OPBC management varied geographically and over time. We recommend establishing an international OPBC patient registry to facilitate longitudinal study and develop global treatment standards.
Appendix
Available only for authorised users
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Metadata
Title
Geographic and Temporal Trends in the Management of Occult Primary Breast Cancer: A Systematic Review and Meta-Analysis
Authors
Oluwadamilola M. Fayanju, MD, MPHS
Carolyn R. T. Stoll, MPH, MSW
Susan Fowler, MLIS
Graham A. Colditz, MD, DrPH
Donna B. Jeffe, PhD
Julie A. Margenthaler, MD
Publication date
01-10-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 10/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3157-5

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