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Preoperative Magnetic Resonance Imaging in Breast Cancer: Meta-Analysis of Surgical Outcomes

Houssami, Nehmat MBBS, PhD*; Turner, Robin PhD*; Morrow, Monica MD

doi: 10.1097/SLA.0b013e31827a8d17

Background and Objective: The role of breast magnetic resonance imaging (MRI) in women newly diagnosed with breast cancer (BC) is controversial. This meta-analysis examines the effect of preoperative MRI compared with standard preoperative assessment on surgical outcomes, focusing on studies that used a controlled design.

Methods: Using random-effects logistic meta-regression modeling, we estimated the proportion of women with each outcome in the MRI versus no-MRI groups, and calculated the odds ratio (OR) and adjusted OR (adjusted for study-level median age, and, where appropriate, for temporal effect) for each model.

Results: There were 9 eligible studies (2 randomized trials; 7 comparative cohorts). Outcomes in 3112 patients with BC (any histological tumor type) for MRI versus no-MRI (referent) were as follows: initial mastectomy 16.4% versus 8.1% [OR, 2.22 (P < 0.001); adjusted OR, 3.06 (P < 0.001)]; re-excision after initial breast conservation 11.6% versus 11.4% [OR, 1.02 (P = 0.87); adjusted OR, 0.95 (P = 0.71)]; overall mastectomy 25.5% versus 18.2% [OR, 1.54 (P < 0.001); adjusted OR, 1.51 (P < 0.001)]. In 766 patients with invasive lobular cancer (ILC), outcomes were as follows: initial mastectomy 31.1% versus 24.9% [OR, 1.36 (P = 0.056); adjusted OR, 2.12 (P = 0.008)]; re-excision after initial breast conservation 10.9% versus 18.0% [OR, 0.56 (P = 0.031); adjusted OR, 0.56 (P = 0.09)]; overall mastectomy 43.0% versus 40.2% [OR, 1.12 (P = 0.45); adjusted OR, 1.64 (P = 0.034)].

Conclusions: Our summary of the evidence showed that MRI significantly increased mastectomy rates and suggests an unfavorable harm-benefit ratio for routine use of preoperative MRI in BC. We found weak evidence that MRI reduced re-excision surgery in patients with ILC —although this was at the expense of increased mastectomies—and overall patient benefit from MRI in ILC is not clear from this study.

Meta-regression modeling of studies using a controlled design to examine the effect of preoperative magnetic resonance imaging (MRI) in breast cancer (3112 patients) showed that using MRI versus standard preoperative assessment (no-MRI) increased the overall mastectomy rate [25.5% vs 18.2%; odds ratio (OR), 1.54 (P < 0.001); adjusted OR, 1.51 (P < 0.001)] and did not reduce re-excision surgery in those with initial breast conservation [11.6% vs 11.4%; OR, 1.02 (P = 0.87); adjusted OR, 0.95 (P = 0.71)].

*Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia

Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

Reprints: Nehmat Houssami, MBBS, PhD, School of Public Health (A27), Sydney Medical School, University of Sydney, Sydney 2006, Australia. E-mail:

Disclosure: Supported by National Health and Medical Research Council program grant No. 633003 to the Screening and Test Evaluation Program.

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© 2013 Lippincott Williams & Wilkins, Inc.