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Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis

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Abstract

Objectives

To estimate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting additional lesions and contralateral cancer not identified using conventional imaging in primary breast cancer.

Methods

We have conducted a systematic review and meta-analyses to estimate diagnostic accuracy indices and the impact of MRI on surgical management.

Results

Fifty articles were included (n = 10,811 women). MRI detected additional disease in 20% of women and in the contralateral breast in 5.5%. The summary PPV of ipsilateral additional disease was 67% (95% CI 59–74%). For contralateral breast, the PPV was 37% (95% CI 27–47%). For ipsilateral lesions, MRI devices ≥1.5 Tesla (T) had higher PPV (75%, 95% CI 64–83%) than MRI with <1.5 T (59%, 95% CI 53–71%). Similar results were found for contralateral cancer, PPV 40% (95% CI 29–53%) and 19% (95% CI 8–39%) for high- and low-field equipments, respectively. True positive MRI findings prompted conversion from wide local excision (WLE) to more extensive surgery in 12.8% of women while in 6.3% this conversion was inappropriate.

Conclusions

MRI shows high diagnostic accuracy, but MRI findings should be pathologically verified because of the high FP rate. Future research on this emerging technology should focus on patient outcome as the primary end-point.

Key Points

• Breast Magnetic Resonance Imaging is becoming increasingly popular for cancer staging before surgery.

• This diagnostic accuracy systematic review and meta-analysis updates previous ones demonstrating MRI has high diagnostic accuracy and causes more extensive surgery.

• Magnetic Resonance protocols at 1.5 T or greater shows greater positive predictive value than lower-field equipments.

• The actual impact on clinical relevant outcomes should be addressed with properly designed randomized controlled trials.

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Acknowledgements

We thank Eukene Ansuategi for her invaluable support with literature searches and retrieval of the full text of the manuscripts. This work has been partially supported by the CIBERESP (grant no. AE08_006) and also funded by the Spanish Ministry of Health (grant no. FIS PI08/90193). We also thank the staff of the Breast Unit of Ramon y Cajal Hospital for their comments on drafts of this manuscript.

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Authors and Affiliations

  1. Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP) and Instituto de Investigación Sanitaria (IRYCIS), Ctra. Colmenar km 9, 100 28034, Madrid, Spain

    María Nieves Plana, Alfonso Muriel, Víctor Abraira & Javier Zamora

  2. Servicio de Diagnóstico por Imagen, Hospital de Fuenlabrada, Madrid, Spain

    Carmen Carreira & Miguel Chiva

  3. Clinical Epidemiology Unit. CASPe, CIBER-ESP, Hospital Donostia, San Sebastián, Spain

    Jose Ignacio Emparanza

  4. Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, CIBER-ESP, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Xavier Bonfill

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  1. María Nieves Plana
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Correspondence to Javier Zamora.

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Plana, M.N., Carreira, C., Muriel, A. et al. Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis. Eur Radiol 22, 26–38 (2012). https://doi.org/10.1007/s00330-011-2238-8

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