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

被引:155
|
作者
Houssami, Nehmat [1 ]
Turner, Robin M. [2 ]
Morrow, Monica [3 ]
机构
[1] Univ Sydney, Sydney Med Sch, Sydney Sch Publ Hlth A27, Sydney, NSW 2006, Australia
[2] Univ New South Wales, Sch Publ Hlth & Community Med, Sydney, NSW, Australia
[3] Mem Sloan Kettering Canc Ctr, Dept Surg, Breast Serv, New York, NY 10021 USA
关键词
Breast cancer; Breast-conserving surgery; Magnetic resonance imaging; Mastectomy; Metaanalysis; Re-operation; WOMEN; IMPACT; MANAGEMENT; CARCINOMA; OUTCOMES; SURGERY; TRENDS;
D O I
10.1007/s10549-017-4324-3
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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.
引用
收藏
页码:273 / 283
页数:11
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