Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer

• Published in: Breast cancer research and treatment Vol. 165; no. 2; pp. 273 - 283
• Main Authors: Houssami, Nehmat, Turner, Robin M., Morrow, Monica
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2017; Springer; Springer Nature B.V
• Subjects: Age; Breast cancer; Breast Neoplasms - diagnosis; Breast Neoplasms - surgery; Cancer research; Cancer therapies; Cancer treatment; Care and treatment; Female; Humans; Invasiveness; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Mastectomy; Mastectomy - methods; Mastectomy, Segmental - methods; Medicine; Medicine & Public Health; Meta-analysis; NMR; Nuclear magnetic resonance; Odds Ratio; Oncology; Preoperative Care - methods; Prognosis; Reoperation; Review; Studies; Surgery; Surgical outcomes; Treatment Outcome; Mastectomy; Re-operation; Breast cancer; Magnetic resonance imaging; Breast-conserving surgery; Meta-analysis
• ISSN: 0167-6806; 1573-7217; 1573-7217
• DOI: 10.1007/s10549-017-4324-3

Background Although there is no consensus on whether pre-operative MRI in women with breast cancer (BC) benefits surgical treatment, MRI continues to be used pre-operatively in practice. This meta-analysis examines the association between pre-operative MRI and surgical outcomes in BC. Methods A systematic review was performed to identify studies reporting quantitative data on pre-operative MRI and surgical outcomes (without restriction by type of surgery received or type of BC) and using a controlled design. Random-effects logistic regression calculated the pooled odds ratio (OR) for each surgical outcome (MRI vs. no-MRI groups), and estimated ORs stratified by study-level age. Subgroup analysis was performed for invasive lobular cancer (ILC). Results Nineteen studies met eligibility criteria: 3 RCTs and 16 comparative studies that included newly diagnosed BC of any type except for three studies restricted to ILC. Primary analysis (85,975 subjects) showed that pre-operative MRI was associated with increased odds of receiving mastectomy [OR 1.39 (1.23, 1.57); p  < 0.001]; similar findings were shown in analyses stratified by study-level median age. Secondary analyses did not find statistical evidence of an effect of MRI on the rates of re-excision, re-operation, or positive margins; however, MRI was significantly associated with increased odds of receiving contralateral prophylactic mastectomy [OR 1.91 (1.25, 2.91); p  = 0.003]. Subgroup analysis for ILC did not find any association between MRI and the odds of receiving mastectomy [OR 1.00 (0.75, 1.33); p  = 0.988] or the odds of re-excision [OR 0.65 (0.35, 1.24); p  = 0.192]. Conclusions Pre-operative MRI is associated with increased odds of receiving ipsilateral mastectomy and contralateral prophylactic mastectomy as surgical treatment in newly diagnosed BC patients.