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Systematic Reviews, Meta-Analyses, and Cost-Effective Analyses on Breast MRI Screening of High-Risk Women

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Breast MRI for High-risk Screening

Abstract

During the last decades, the rules of evidence-based medicine have increasingly influenced clinical practice and progressively expanded their role from therapy to diagnostics. Secondary studies, that are finalized to summarize the evidence available in the published literature on a given topic, acquired a prominent role in the decision to recommend in favor or against a medical technology. These studies favored the adoption of breast MRI for screening high-risk women by governmental bodies and guidelines. Thus, in this chapter we: (1) describe systematic reviews and meta-analyses (SR&MAs) in the context of contemporary medicine and the practice of healthcare systems; (2) provide a brief history of SRs; (3) present an overview of the methods of SRs and of MAs, including the differentiation between study-level, also called aggregate-data MAs, and individual-patient (or -participant) data MAs, summarizing their advantages and limitations; (4) present the results of SR&MAs performed on breast MRI for screening high-risk women, looking not only at reinforced knowledge about the capability of MRI but also at new knowledge acquired through meta-analytic methods that the original individual primary studies were not able to provide; and (5) examine the contributions of cost-effective analyses to this topic.

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Notes

  1. 1.

    There are cases when the systematic review (and the selection of published papers) cannot generate data suitable for a new synthesis. In these circumstances, we will have the systematic review with the description of the available data, without the meta-analysis.

  2. 2.

    Note that in this context the term technology refers to any medical or surgical practice as well as to any medicines or devices.

  3. 3.

    Note that survival and mortality are not supplementary quantities. This is due to the fact that survival is usually computed on a cohort of patients diagnosed with a disease while mortality is computed as rate for inhabitants of a given territory. In the case of relevant increase of overdiagnosis, temporal trends for the two quantities can be strongly contradictory: strong increase of survival versus stability of mortality.

  4. 4.

    The reader can find an extended discussion on the impact of breast MRI high-risk screening on patient outcome in Chap. 13.

  5. 5.

    The reader can find further material on the possibility to use breast MRI only for screening high-risk women and on the risk of radio-induced BCs in this particular population in Chaps. 9 and 10 and in Chap. 12, respectively.

  6. 6.

    The reader can find an extended discussion on breast MRI screening for the intermediate risk in Chap. 22.

Abbreviations

AD:

Aggregate data

AUC:

Area under the curve

BC:

Breast cancer

CBE:

Clinical breast examination

CEA:

Cost-effectiveness analysis

CI:

Confidence interval

EBM:

Evidence-based medicine

HTA:

Health technology assessment

IPD:

Individual patient data

LTR:

Lifetime risk

MA:

Meta-analysis

MRI:

Magnetic resonance imaging

NLR:

Negative likelihood ratio

NSN:

Number of screens needed

PLR:

Positive likelihood ratio

PPV:

Positive predictive value

QALYs:

Quality-adjusted life years

ROC:

Receiver operating characteristics

SR:

Systematic review

US:

Ultrasonography, Ultrasound

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Author information

Authors and Affiliations

  1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Francesco Sardanelli

  2. Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy

    Francesco Sardanelli & Giovanni Di Leo

  3. Sydney School of Public Health (A27), Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Nehmat Houssami

Authors
  1. Francesco Sardanelli
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  2. Giovanni Di Leo
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  3. Nehmat Houssami
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Corresponding author

Correspondence to Francesco Sardanelli .

Editor information

Editors and Affiliations

  1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Francesco Sardanelli

  2. Department of Cell Biology and Neurosciences Molecular and Cellular Imaging Unit, Istituto Superiore di Sanità (ISS), Rome, Italy

    Franca Podo

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Sardanelli, F., Di Leo, G., Houssami, N. (2020). Systematic Reviews, Meta-Analyses, and Cost-Effective Analyses on Breast MRI Screening of High-Risk Women. In: Sardanelli, F., Podo, F. (eds) Breast MRI for High-risk Screening. Springer, Cham. https://doi.org/10.1007/978-3-030-41207-4_11

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  • DOI: https://doi.org/10.1007/978-3-030-41207-4_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-41206-7

  • Online ISBN: 978-3-030-41207-4

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