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



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.


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).


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].


Pre-operative MRI is associated with increased odds of receiving ipsilateral mastectomy and contralateral prophylactic mastectomy as surgical treatment in newly diagnosed BC patients.


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



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)


  1. 1.
    Morrow M, Waters J, Morris E (2011) MRI for breast cancer screening, diagnosis, and treatment. Lancet 378:1804–1811CrossRefPubMedGoogle Scholar
  2. 2.
    Houssami N, Hayes DF (2009) Review of preoperative magnetic resonance imaging (MRI) in breast cancer: should MRI be performed on all women with newly diagnosed, early stage breast cancer? CA Cancer J Clin 59:290–302CrossRefPubMedGoogle Scholar
  3. 3.
    Turnbull L, Brown S, Harvey I et al (2010) Comparative effectiveness of MRI in breast cancer (COMICE) trial: a randomised controlled trial. Lancet 375:563–571CrossRefPubMedGoogle Scholar
  4. 4.
    Pilewskie M, King TA (2014) Magnetic resonance imaging in patients with newly diagnosed breast cancer: a review of the literature. Cancer 120:2080–2089CrossRefPubMedGoogle Scholar
  5. 5.
    Jatoi I, Benson JR (2013) The case against routine preoperative breast MRI [review]. Future Oncol 9:347–353CrossRefPubMedGoogle Scholar
  6. 6.
    Houssami N, Turner R, Morrow M (2013) Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes. Ann Surg 257:249–255CrossRefPubMedGoogle Scholar
  7. 7.
    Solin LJ, Orel SG, Hwang WT, Harris EE, Schnall MD (2008) Relationship of breast magnetic resonance imaging to outcome after breast-conservation treatment with radiation for women with early-stage invasive breast carcinoma or ductal carcinoma in situ. J Clin Oncol 26:386–391CrossRefPubMedGoogle Scholar
  8. 8.
    Kuhl C, Kuhn W, Braun M, Schild H (2007) Pre-operative staging of breast cancer with breast MRI: one step forward, two steps back? Breast 16:34–44CrossRefGoogle Scholar
  9. 9.
    Morrow M (2008) Magnetic resonance imaging in the breast cancer patient: curb your enthusiasm. J Clin Oncol 26:352–353CrossRefPubMedGoogle Scholar
  10. 10.
    Sardanelli F, Boetes C, Borisch B et al (2010) Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer 46:1296–1316CrossRefPubMedGoogle Scholar
  11. 11.
    Brennan ME, Houssami N, Lord S et al (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 27:5640–5649CrossRefPubMedGoogle Scholar
  12. 12.
    Ciatto S (2010) Pre-operative breast MRI: what do women want? Breast 19:435–436CrossRefPubMedGoogle Scholar
  13. 13.
    Houssami N, Ciatto S, Macaskill P et al (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 26:3248–3258CrossRefPubMedGoogle Scholar
  14. 14.
    Fortune-Greeley AK, Wheeler SB, Meyer AM et al (2014) Preoperative breast MRI and surgical outcomes in elderly women with invasive ductal and lobular carcinoma: a population-based study. Breast Cancer Res Treat 143:203–212CrossRefPubMedGoogle Scholar
  15. 15.
    Gonzalez V, Sandelin K, Karlsson A et al (2014) Preoperative MRI of the breast (POMB) influences primary treatment in breast cancer: a prospective, randomized, multicenter study. World J Surg 38:1685–1693CrossRefPubMedGoogle Scholar
  16. 16.
    Petrillo A, Porto A, Fusco R et al (2013) Surgical impact of preoperative breast MRI in women below 40 years of age. Breast Cancer Res Treat 140:527–533CrossRefPubMedGoogle Scholar
  17. 17.
    Landercasper J, Bailey L, Berry TS et al (2016) Measures of appropriateness and value for breast surgeons and their patients: the American Society of breast surgeons choosing wisely initiative. Ann Surg Oncol 23:3112–3118CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gradishar WJ, Anderson BO, Balassanian R et al (2016) Invasive breast cancer version 1.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 14:324–354CrossRefGoogle Scholar
  19. 19.
    American College of Radiology (ACR). ACR practice guideline for the performance of contrast-enhanced magnetic resonance imaging (MRI) of the breast. 2008Google Scholar
  20. 20.
    Peters NH, van ES, van den Bosch MA et al (2011) Preoperative MRI and surgical management in patients with nonpalpable breast cancer: the MONET - randomised controlled trial. Eur J Cancer 47:879–886CrossRefPubMedGoogle Scholar
  21. 21.
    Bleicher RJ, Ciocca RM, Egleston BL et al (2009) Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg 209:180–187CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Pengel KE, Loo CE, Teertstra HJ et al (2009) The impact of preoperative MRI on breast-conserving surgery of invasive cancer: a comparative cohort study. Breast Cancer Res Treat 116:161–169CrossRefPubMedGoogle Scholar
  23. 23.
    Miller B, Abbott A, Tuttle T (2012) The influence of preoperative MRI on breast cancer treatment. Ann Surg Oncol 19:536–540CrossRefPubMedGoogle Scholar
  24. 24.
    Grady I, Gorsuch-Rafferty H, Hadley P (2012) Preoperative staging with magnetic resonance imaging, with confirmatory biopsy, improves surgical outcomes in women with breast cancer without increasing rates of mastectomy. Breast J 18:214–218CrossRefPubMedGoogle Scholar
  25. 25.
    Weber JJ, Bellin LS, Milbourn DE, Verbanac KM, Wong JH (2012) Selective preoperative magnetic resonance imaging in women with breast cancer: no reduction in the reoperation rate. Arch Surg 147:834–839CrossRefPubMedGoogle Scholar
  26. 26.
    Killelea BK, Long JB, Chagpar AB et al (2013) Trends and clinical implications of preoperative breast MRI in medicare beneficiaries with breast cancer. Breast Cancer Res Treat 141:155–163CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Killelea BK, Grube BJ, Rishi M, Philpotts L, Tran EJ, Lannin DR (2013) Is the use of preoperative breast MRI predictive of mastectomy? World J Surg Oncol 11:154CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Chandwani S, George PA, Azu M et al (2014) Role of preoperative magnetic resonance imaging in the surgical management of early-stage breast cancer. Ann Surg Oncol 21:3473–3480CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Arnaout A, Catley C, Booth CM et al (2015) Use of preoperative magnetic resonance imaging for breast cancer: a Canadian population-based study. JAMA Oncol 1:1238–1250CrossRefPubMedGoogle Scholar
  30. 30.
    Vos EL, Voogd AC, Verhoef C, Siesling S, Obdeijn IM, Koppert LB (2015) Benefits of preoperative MRI in breast cancer surgery studied in a large population-based cancer registry. Br J Surg 102:1649–1657CrossRefPubMedGoogle Scholar
  31. 31.
    Parsyan A, Moldoveanu D, Balram B et al (2016) Influence of preoperative magnetic resonance imaging on the surgical management of breast cancer patients. Am J Surg 211:1089–1094CrossRefPubMedGoogle Scholar
  32. 32.
    Mann RM, Loo CE, Wobbes T et al (2010) The impact of preoperative breast MRI on the re-excision rate in invasive lobular carcinoma of the breast. Breast Cancer Res Treat 119:415–422CrossRefPubMedGoogle Scholar
  33. 33.
    (33) McGhan LJ, Wasif N, Gray RJ et al. Use of preoperative magnetic resonance imaging for invasive lobular cancer: good, better, but maybe not the best? Annals of Surgical Oncology 2010;17:Suppl-62Google Scholar
  34. 34.
    Heil J, Buhler A, Golatta M et al (2011) Does a supplementary preoperative breast MRI in patients with invasive lobular breast cancer change primary and secondary surgical interventions? Ann Surg Oncol 18:2143–2149CrossRefPubMedGoogle Scholar
  35. 35.
    Fancellu A, Turner RM, Dixon JM, Pinna A, Cottu P, Houssami N (2015) Meta-analysis of the effect of preoperative breast MRI on the surgical management of ductal carcinoma in situ. Br J Surg 102:883–893CrossRefPubMedGoogle Scholar
  36. 36.
    Marinovich ML, Houssami N, Macaskill P et al (2013) Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. J Natl Cancer Inst 105:321–333CrossRefPubMedGoogle Scholar
  37. 37.
    Marinovich ML, Macaskill P, Irwig L et al (2013) Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy. Br J Cancer 109:1528–1536CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Houssami N, Turner R, Macaskill P et al (2014) An individual person data meta-analysis of preoperative magnetic resonance imaging and breast cancer recurrence. J Clin Oncol 32:392–401CrossRefPubMedGoogle Scholar
  39. 39.
    Vapiwala N, Hwang WT, Kushner CJ, Schnall MD, Freedman GM, Solin LJ (2017) No impact of breast magnetic resonance imaging on 15-year outcomes in patients with ductal carcinoma in situ or early-stage invasive breast cancer managed with breast conservation therapy. Cancer 123:1324–1332CrossRefPubMedGoogle Scholar
  40. 40.
    Stout NK, Nekhlyudov L, Li L et al (2014) Rapid increase in breast magnetic resonance imaging use: trends from 2000 to 2011. JAMA Intern Med 174:114–121CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Wernli KJ, DeMartini WB, Ichikawa L et al (2014) Patterns of breast magnetic resonance imaging use in community practice. JAMA Intern Med 174:125–132CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Morrow, Abrahamse P, Hofer TP, Ward KC, et al (2017) Trends in reoperation after initial lumpectomy for breast cancer: addressing overtreatment in surgical management. Ann Surg Oncol (in press)Google Scholar
  43. 43.
    Brennan ME, McKessar M, Snook K, Burgess I, Spillane AJ (2017) Impact of selective use of breast MRI on surgical decision-making in women with newly diagnosed operable breast cancer. Breast 32:135–143CrossRefPubMedGoogle Scholar
  44. 44.
    Onega T, Tosteson AN, Weiss J et al (2016) Costs of diagnostic and preoperative workup with and without breast MRI in older women with a breast cancer diagnosis. BMC Health Serv Res 16:76CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Knuttel FM, Menezes GL, van den Bosch MA, Gilhuijs KG, Peters NH (2014) Current clinical indications for magnetic resonance imaging of the breast. J Surg Oncol 110:26–31CrossRefPubMedGoogle Scholar
  46. 46.
    Saini V, Garcia-Armesto S, Klemperer D et al (2017) Drivers of poor medical care. Lancet 06:2017Google Scholar
  47. 47.
    Brownlee S, Chalkidou K, Doust J et al (2017) Evidence for overuse of medical services around the world. LancetGoogle Scholar

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

Personalised recommendations