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Breast Cancer Research and Treatment

, Volume 165, Issue 2, pp 273–283 | Cite as

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

  • Nehmat Houssami
  • Robin M. Turner
  • Monica Morrow
Review

Abstract

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.

Keywords

Breast cancer Breast-conserving surgery Magnetic resonance imaging Mastectomy Meta-analysis Re-operation 

Notes

Funding

NH receives funding via a National Breast Cancer Foundation (Australia) Breast Cancer Research Leadership Fellowship.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

10549_2017_4324_MOESM1_ESM.docx (54 kb)
Supplementary material 1 (DOCX 53 kb)
10549_2017_4324_MOESM2_ESM.docx (23 kb)
Supplementary material 2 (DOCX 22 kb)

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Sydney School of Public Health (A27), Sydney Medical SchoolUniversity of SydneySydneyAustralia
  2. 2.School of Public Health and Community MedicineUniversity of New South WalesSydneyAustralia
  3. 3.Breast Service, Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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