A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical Excision
Objective:. To examine the association between the performance of mapping biopsies and surgical outcomes postexcision of extramammary Paget’s disease (EMPD). Background:. Primary EMPD is a rare entity associated with poorly defined surgical margins and difficult-to-access sites of lesions. Surgical...
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Wolters Kluwer Health
2023-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000339 |
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| author | Thirrisha Murugan Louis Choon Kit Wong, MD Xing-Yi Sarah Ong, MD Sze Huey Tan, PhD Joey Wee-Shan Tan, MSc Ying Liu, PhD Nicholas B. Shannon, PhD, MD Jianbang Chiang, MBBS, MRCP, MMed Eileen Poon, MBBS, MRCP, MMED Jason Yongsheng Chan, MBBS, MRCP, MMed, FAMS, PhD Valerie Shiwen Yang, MB BChir, PhD, MRCP, FAMS Nagavalli Somasundaram, MBBS, MRCP, MMED Mohamad Farid, MBBS, MRCP, MMed Ru Xin Wong, MBBS, FRCR Wen Long Nei, MBBS, FRCR Jin Wei Kwek, MBBS, FRCR, FAMS Choon Hua Thng, MBBS, FRCR, FAMS Tiffany Hennedige, MBBS, FRCR, MMed, MCI Po Yin Tang, BMEDSc, MBBS, FRCPath, FRCAPA Sathiyamoorthy Selvarajan, MBBS, PGDCP, FRCPath, MCS, FAMS Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS Mohamed Rezal Abdul, MB, BCh, BAO, LRCP&SI, MSurg Jolene Si Min Wong, MBBS, MMed, FRCS Chin Jin Seo, MB, BCh, BAO, MMed, FRCS Khee Chee Soo, MBBS, MD, FRACS, FACS Claramae Shulyn Chia, MBBS, MMed, FRCS Chin-Ann Johnny Ong, MBBS, MMed, FRCS, PhD |
| author_facet | Thirrisha Murugan Louis Choon Kit Wong, MD Xing-Yi Sarah Ong, MD Sze Huey Tan, PhD Joey Wee-Shan Tan, MSc Ying Liu, PhD Nicholas B. Shannon, PhD, MD Jianbang Chiang, MBBS, MRCP, MMed Eileen Poon, MBBS, MRCP, MMED Jason Yongsheng Chan, MBBS, MRCP, MMed, FAMS, PhD Valerie Shiwen Yang, MB BChir, PhD, MRCP, FAMS Nagavalli Somasundaram, MBBS, MRCP, MMED Mohamad Farid, MBBS, MRCP, MMed Ru Xin Wong, MBBS, FRCR Wen Long Nei, MBBS, FRCR Jin Wei Kwek, MBBS, FRCR, FAMS Choon Hua Thng, MBBS, FRCR, FAMS Tiffany Hennedige, MBBS, FRCR, MMed, MCI Po Yin Tang, BMEDSc, MBBS, FRCPath, FRCAPA Sathiyamoorthy Selvarajan, MBBS, PGDCP, FRCPath, MCS, FAMS Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS Mohamed Rezal Abdul, MB, BCh, BAO, LRCP&SI, MSurg Jolene Si Min Wong, MBBS, MMed, FRCS Chin Jin Seo, MB, BCh, BAO, MMed, FRCS Khee Chee Soo, MBBS, MD, FRACS, FACS Claramae Shulyn Chia, MBBS, MMed, FRCS Chin-Ann Johnny Ong, MBBS, MMed, FRCS, PhD |
| author_sort | Thirrisha Murugan |
| collection | DOAJ |
| description | Objective:. To examine the association between the performance of mapping biopsies and surgical outcomes postexcision of extramammary Paget’s disease (EMPD).
Background:. Primary EMPD is a rare entity associated with poorly defined surgical margins and difficult-to-access sites of lesions. Surgical resection with clear margins remains the preferred management method. The use of mapping biopsies might be beneficial, particularly in lowering disease recurrence.
Methods:. Available literature was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology before a fixed-effect meta-analysis was performed to identify the presence of a correlation between performing mapping biopsies and positive margins on permanent sections as well as disease-free survival. Additional study results not included in the quantitative assessment were qualitatively assessed and reported.
Results:. A total of 12 studies were shortlisted for final analysis. 294 patients who underwent mapping biopsies and 48 patients who did not undergo mapping biopsies were included in the assessment. Forest plot analysis revealed a pooled rate ratio of 0.50 (95% CI, 0.32–0.77) in the prevalence of positive margins in patients with mapping biopsies performed as compared to patients without. The pooled rate ratio of the prevalence of disease-free survival in patients with mapping biopsies performed as compared to patients without was 1.38 (95% CI, 1.03–1.84). Qualitative assessment of the remaining selected studies revealed equivocal results.
Conclusions:. Mapping biopsies are able to improve EMPD surgical excision outcomes but given the rarity of the disease and heterogeneity of mapping biopsy procedures, further confirmation with randomized controlled trials or a larger patient pool is necessary. |
| format | Article |
| id | doaj-art-589c0f67ac2448b1839449eb040494f7 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-589c0f67ac2448b1839449eb040494f72025-01-24T09:18:12ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932023-12-0144e33910.1097/AS9.0000000000000339202312000-00009A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical ExcisionThirrisha Murugan0Louis Choon Kit Wong, MD1Xing-Yi Sarah Ong, MD2Sze Huey Tan, PhD3Joey Wee-Shan Tan, MSc4Ying Liu, PhD5Nicholas B. Shannon, PhD, MD6Jianbang Chiang, MBBS, MRCP, MMed7Eileen Poon, MBBS, MRCP, MMED8Jason Yongsheng Chan, MBBS, MRCP, MMed, FAMS, PhD9Valerie Shiwen Yang, MB BChir, PhD, MRCP, FAMS10Nagavalli Somasundaram, MBBS, MRCP, MMED11Mohamad Farid, MBBS, MRCP, MMed12Ru Xin Wong, MBBS, FRCR13Wen Long Nei, MBBS, FRCR14Jin Wei Kwek, MBBS, FRCR, FAMS15Choon Hua Thng, MBBS, FRCR, FAMS16Tiffany Hennedige, MBBS, FRCR, MMed, MCI17Po Yin Tang, BMEDSc, MBBS, FRCPath, FRCAPA18Sathiyamoorthy Selvarajan, MBBS, PGDCP, FRCPath, MCS, FAMS19Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS20Mohamed Rezal Abdul, MB, BCh, BAO, LRCP&SI, MSurg21Jolene Si Min Wong, MBBS, MMed, FRCS22Chin Jin Seo, MB, BCh, BAO, MMed, FRCS23Khee Chee Soo, MBBS, MD, FRACS, FACS24Claramae Shulyn Chia, MBBS, MMed, FRCS25Chin-Ann Johnny Ong, MBBS, MMed, FRCS, PhD26From the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, Singapore‡ Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, Singapore‖ Division of Medical Oncology, National Cancer Centre Singapore, Singapore‖ Division of Medical Oncology, National Cancer Centre Singapore, Singapore‖ Division of Medical Oncology, National Cancer Centre Singapore, Singapore‖ Division of Medical Oncology, National Cancer Centre Singapore, Singapore‖ Division of Medical Oncology, National Cancer Centre Singapore, Singapore‖ Division of Medical Oncology, National Cancer Centre Singapore, Singapore†† Division of Radiation Oncology, National Cancer Centre Singapore, Singapore** SingHealth Duke-NUS Oncology Academic Clinical Program, Duke NUS Medical School, Singapore** SingHealth Duke-NUS Oncology Academic Clinical Program, Duke NUS Medical School, Singapore‡‡ Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore‡‡ Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore§§ Department of Anatomical Pathology, Singapore General Hospital, Singapore§§ Department of Anatomical Pathology, Singapore General Hospital, Singapore¶¶ Division of Surgery and Surgical Oncology, Department of Urology, Singapore General Hospital, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeFrom the * Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), National Cancer Centre Singapore, SingaporeObjective:. To examine the association between the performance of mapping biopsies and surgical outcomes postexcision of extramammary Paget’s disease (EMPD). Background:. Primary EMPD is a rare entity associated with poorly defined surgical margins and difficult-to-access sites of lesions. Surgical resection with clear margins remains the preferred management method. The use of mapping biopsies might be beneficial, particularly in lowering disease recurrence. Methods:. Available literature was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology before a fixed-effect meta-analysis was performed to identify the presence of a correlation between performing mapping biopsies and positive margins on permanent sections as well as disease-free survival. Additional study results not included in the quantitative assessment were qualitatively assessed and reported. Results:. A total of 12 studies were shortlisted for final analysis. 294 patients who underwent mapping biopsies and 48 patients who did not undergo mapping biopsies were included in the assessment. Forest plot analysis revealed a pooled rate ratio of 0.50 (95% CI, 0.32–0.77) in the prevalence of positive margins in patients with mapping biopsies performed as compared to patients without. The pooled rate ratio of the prevalence of disease-free survival in patients with mapping biopsies performed as compared to patients without was 1.38 (95% CI, 1.03–1.84). Qualitative assessment of the remaining selected studies revealed equivocal results. Conclusions:. Mapping biopsies are able to improve EMPD surgical excision outcomes but given the rarity of the disease and heterogeneity of mapping biopsy procedures, further confirmation with randomized controlled trials or a larger patient pool is necessary.http://journals.lww.com/10.1097/AS9.0000000000000339 |
| spellingShingle | Thirrisha Murugan Louis Choon Kit Wong, MD Xing-Yi Sarah Ong, MD Sze Huey Tan, PhD Joey Wee-Shan Tan, MSc Ying Liu, PhD Nicholas B. Shannon, PhD, MD Jianbang Chiang, MBBS, MRCP, MMed Eileen Poon, MBBS, MRCP, MMED Jason Yongsheng Chan, MBBS, MRCP, MMed, FAMS, PhD Valerie Shiwen Yang, MB BChir, PhD, MRCP, FAMS Nagavalli Somasundaram, MBBS, MRCP, MMED Mohamad Farid, MBBS, MRCP, MMed Ru Xin Wong, MBBS, FRCR Wen Long Nei, MBBS, FRCR Jin Wei Kwek, MBBS, FRCR, FAMS Choon Hua Thng, MBBS, FRCR, FAMS Tiffany Hennedige, MBBS, FRCR, MMed, MCI Po Yin Tang, BMEDSc, MBBS, FRCPath, FRCAPA Sathiyamoorthy Selvarajan, MBBS, PGDCP, FRCPath, MCS, FAMS Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS Mohamed Rezal Abdul, MB, BCh, BAO, LRCP&SI, MSurg Jolene Si Min Wong, MBBS, MMed, FRCS Chin Jin Seo, MB, BCh, BAO, MMed, FRCS Khee Chee Soo, MBBS, MD, FRACS, FACS Claramae Shulyn Chia, MBBS, MMed, FRCS Chin-Ann Johnny Ong, MBBS, MMed, FRCS, PhD A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical Excision Annals of Surgery Open |
| title | A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical Excision |
| title_full | A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical Excision |
| title_fullStr | A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical Excision |
| title_full_unstemmed | A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical Excision |
| title_short | A Systematic Review and Meta-Analysis of Mapping Biopsy for Primary Extramammary Paget’s Disease in Reducing Recurrence Following Surgical Excision |
| title_sort | systematic review and meta analysis of mapping biopsy for primary extramammary paget s disease in reducing recurrence following surgical excision |
| url | http://journals.lww.com/10.1097/AS9.0000000000000339 |
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