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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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.
We have conducted a systematic review and meta-analyses to estimate diagnostic accuracy indices and the impact of MRI on surgical management.
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.
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.
• 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.
KeywordsBreast cancer Magnetic resonance imaging Sensitivity and specificity Systematic review Meta-analysis
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.
- 1.Sardanelli F, Boetes C, Borisch B, Decker T, Federico M, Gilbert FJ, Helbich T, Heywang-Kobrunner SH, Kaiser WA, Kerin MJ, Mansel RE, Marotti L, Martincich L, Mauriac L, Meijers-Heijboer H, Orecchia R, Panizza P, Ponti A, Purushotham AD, Regitnig P, Del Turco MR, Thibault F, Wilson R (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316PubMedCrossRefGoogle Scholar
- 7.Mumtaz H, Hall-Craggs MA, Davidson T, Walmsley K, Thurell W, Kissin MW, Taylor I (1997) Staging of symptomatic primary breast cancer with MR imaging. Am J Roentgenol 169(2):417–24Google Scholar
- 9.Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, Irwig L (2008) Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol 26:3248–3258PubMedCrossRefGoogle Scholar
- 10.Lehman CD, Gatsonis C, Kuhl CK, Hendrick RE, Pisano ED, Hanna L, Peacock S, Smazal SF, Maki DD, Julian TB, DePeri ER, Bluemke DA, Schnall MD, ACRIN T (2007) MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. N Engl J Med 356:1295–1303PubMedCrossRefGoogle Scholar
- 11.Brennan ME, Houssami N, Lord S, Macaskill P, Irwig L, Dixon JM, Warren RM, Ciatto S (2009) Magnetic resonance imaging screening of the contralateral breast in women with newly diagnosed breast cancer: systematic review and meta-analysis of incremental cancer detection and impact on surgical management. J Clin Oncol 27:5640–5649PubMedCrossRefGoogle Scholar
- 16.Harbord RM (2008) Metandi:Stata module for meta-analysis of diagnostic accuracy. Statistical Software Components, Boston College Department of Economics. Revised 15 Apr 2008Google Scholar
- 17.SAS Institute: SAS/STAT User’s Guide, version 9.1. (Cary (NC):SAS Institute, 1999). 2010Google Scholar
- 19.Olivas-Maguregui S, Villasenor-Navarro Y, Ferrari-Carballo T, Morales-Chairez V, Michel-Ortega RM, Ceron-Lizarraga T, Silva-Godinez JC, Arrieta O (2008) Importance of the preoperative evaluation of multifocal and multicentric breast cancer with magnetic resonance imaging in women with dense parenchyma. Rev Invest Clin 60:382–389PubMedGoogle Scholar
- 22.Pediconi F, Venditti F, Padula S, Roselli A, Moriconi E, Giacomelli L, Catalano C, Passariello R (2005) CE-Magnetic Resonance Mammography for the evaluation of the contralateral breast in patients with diagnosed breast cancer. Radiol Med (Torino) 110:61–68Google Scholar
- 29.Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, Lattanzio V, Del MA, Italian Trial for Breast MR in Multifocal/Multicentric Cancer (2004) Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. Am J Roentgenol 183(4):1149–57Google Scholar
- 30.Fischer U, Vosshenrich R, Probst A, Burchhardt H, Grabbe E (1994) Preoperative MR mammography in patients with breast cancer—Useful information or useless extravagance? 161(4):300–306Google Scholar
- 34.Liberman L, Morris EA, Kim CM, Kaplan JB, Abramson AF, Menell JH, Van Zee KJ, Dershaw DD (2003) MR imaging findings in the contralateral breast of women with recently diagnosed breast cancer. Am J Roentgenol 180(2):333–41Google Scholar
- 35.Lehman CD, Blume JD, Thickman D, Bluemke DA, Pisano E, Kuhl C, Julian TB, Hylton N, Weatherall P, O’Loughlin M, Schnitt SJ, Gatsonis C, Schnall MD (2005) Added cancer yield of MRI in screening the contralateral breast of women recently diagnosed with breast cancer: results from the International Breast Magnetic Resonance Consortium (IBMC) trial. J Surg Oncol 92:9–15PubMedCrossRefGoogle Scholar
- 44.Bernard JR Jr, Vallow LA, DePeri ER, McNeil RB, Feigel DG, Amar S, Buskirk SJ, Perez EA (2010) In newly diagnosed breast cancer, screening MRI of the contralateral breast detects mammographically occult cancer, even in elderly women: the mayo clinic in Florida experience. Breast J 16:118–126PubMedCrossRefGoogle Scholar
- 51.Drew PJ, Chatterjee S, Turnbull LW, Read J, Carleton PJ, Fox JN, Monson JR, Kerin MJ (1999) Dynamic contrast enhanced magnetic resonance imaging of the breast is superior to triple assessment for the pre-operative detection of multifocal breast cancer. Ann Surg Oncol 6:599–603PubMedCrossRefGoogle Scholar
- 55.Hlawatsch A, Teifke A, Schmidt M, Thelen M (2002) Preoperative assessment of breast cancer: sonography versus MR imaging. Am J Roentgenol 179(6):1493–501Google Scholar
- 59.Liberman L, Morris EA, Dershaw DD, Abramson AF, Tan LK (2003) MR imaging of the ipsilateral breast in women with percutaneously proven breast cancer. Am J Roentgenol 180(4):901–10Google Scholar
- 60.Lim HI, Choi JH, Yang JH, Han BK, Lee JE, Lee SK, Kim WW, Kim S, Kim JS, Kim JH, Choe JH, Cho EY, Kang SS, Shin JH, Ko EY, Kim SW, Nam SJ (2010) Does pre-operative breast magnetic resonance imaging in addition to mammography and breast ultrasonography change the operative management of breast carcinoma? Breast Canc Res Treat 119:163–167CrossRefGoogle Scholar
- 63.Pediconi F, Catalano C, Roselli A, Padula S, Altomari F, Moriconi E, Pronio AM, Kirchin MA, Passariello R (2007) Contrast-enhanced MR mammography for evaluation of the contralateral breast in patients with diagnosed unilateral breast cancer or high-risk lesions. Radiology 243:670–680PubMedCrossRefGoogle Scholar
- 64.Schelfout K, Van GM, Kersschot E, Colpaert C, Schelfhout AM, Leyman P, Verslegers I, Biltjes I, Van den HJ, Gillardin JP, Tjalma W, Van der Auwera JC, Buytaert P, De SA (2004) Contrast-enhanced MR imaging of breast lesions and effect on treatment. Eur J Surg Oncol 30:501–507PubMedCrossRefGoogle Scholar
- 66.Schnall MD, Blume J, Bluemke DA, Deangelis GA, Debruhl N, Harms S, Heywang-Kobrunner SH, Hylton N, Kuhl CK, Pisano ED, Causer P, Schnitt SJ, Smazal SF, Stelling CB, Lehman C, Weatherall PT, Gatsonis CA (2005) MRI detection of distinct incidental cancer in women with primary breast cancer studied in IBMC 6883. J Surg Oncol 92:32–38PubMedCrossRefGoogle Scholar
- 69.Pinker K, Grabner G, Bogner W, Gruber S, Szomolanyi P, Trattnig S, Heinz-Peer G, Weber M, Fitzal F, Pluschnig U, Rudas M, Helbich T (2009) A combined high temporal and high spatial resolution 3 Tesla MR imaging protocol for the assessment of breast lesions: initial results. Invest Radiol 44:553–558PubMedCrossRefGoogle Scholar