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

被引:217
作者
Brennan, Meagan Elizabeth
Houssami, Nehmat [1 ]
Lord, Sarah
Macaskill, Petra
Irwig, Les
Dixon, J. Michael
Warren, Ruth M. L.
Ciatto, Stefano
机构
[1] Univ Sydney, Screening & Test Evaluat Program, Sch Publ Hlth, Fac Med, Sydney, NSW 2006, Australia
基金
英国医学研究理事会;
关键词
MR MAMMOGRAPHY; PROGNOSTIC-SIGNIFICANCE; PREOPERATIVE ASSESSMENT; LOBULAR CARCINOMA; LESIONS; ACCURACY; THERAPY; RISK;
D O I
10.1200/JCO.2008.21.5756
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Preoperative magnetic resonance imaging (MRI) is increasingly used for staging women with breast cancer, including screening for occult contralateral cancer. This article is a review and meta-analysis of studies reporting contralateral MRI in women with newly diagnosed invasive breast cancer. Methods We systematically reviewed the evidence on contralateral MRI, calculating pooled estimates for positive predictive value (PPV), true-positive: false-positive ratio (TP:FP), and incremental cancer detection rate (ICDR) over conventional imaging. Random effects logistic regression examined whether estimates were associated with study quality or clinical variables. Results Twenty-two studies reported contralateral malignancies detected only by MRI in 131 of 3,253 women. Summary estimates were as follows: MRI-detected suspicious findings (TP plus FP), 9.3% (95% CI, 5.8% to 14.7%); ICDR, 4.1% (95% CI, 2.7% to 6.0%), PPV, 47.9% (95% CI, 31.8% to 64.6%); TP: FP ratio, 0.92 (95% CI, 0.47 to 1.82). PPV was associated with the number of test positives and baseline imaging. Few studies included consecutive women, and few ascertained outcomes in all subjects. Where reported, 35.1% of MRI-detected cancers were ductal carcinoma in situ (mean size = 6.9 mm), 64.9% were invasive cancers (mean size = 9.3 mm), and the majority were stage pTis or pT1 and node negative. Effect on treatment was inconsistently reported, but many women underwent contralateral mastectomy. Conclusion MRI detects contralateral lesions in a substantial proportion of women, but does not reliably distinguish benign from malignant findings. Relatively high ICDR may be due to selection bias and/or overdetection. Women must be informed of the uncertain benefit and potential harm, including additional investigations and surgery.
引用
收藏
页码:5640 / 5649
页数:10
相关论文
共 47 条
[1]   The role of magnetic resonance imaging mammography in the surgical management of the index breast cancer [J].
Bagley, FH .
ARCHIVES OF SURGERY, 2004, 139 (04) :380-383
[2]   Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer [J].
Berg, WA ;
Gutierrez, L ;
NessAiver, MS ;
Carter, WB ;
Bhargavan, M ;
Lewis, RS ;
Ioffe, OB .
RADIOLOGY, 2004, 233 (03) :830-849
[3]   Evaluating the impact of preoperative breast magnetic resonance imaging on the surgical management of newly diagnosed breast cancers - Discussion [J].
Grube, Baiba J. ;
Bethke, Kevin P. ;
Harken, Alden H. ;
Velasco, Jose M. .
ARCHIVES OF SURGERY, 2007, 142 (05) :445-447
[4]   Does preoperative magnetic resonance imaging modify breast cancer surgery ? [J].
Buxant, F. ;
Scuotto, F. ;
Hottat, N. ;
Noel, J. C. ;
Simon, P. .
ACTA CHIRURGICA BELGICA, 2007, 107 (03) :288-291
[5]   The long-term outcome of synchronous bilateral breast cancer is worse than metachronous or unilateral tumours [J].
Carmichael, AR ;
Bendall, S ;
Lockerbie, L ;
Prescott, R ;
Bates, T .
EUROPEAN JOURNAL OF SURGICAL ONCOLOGY, 2002, 28 (04) :388-391
[6]   Additional breast lesions in patients eligible for breast-conserving therapy by MRI: Impact on preoperative management and potential benefit of computerised analysis [J].
Deurloo, EE ;
Peterse, JL ;
Rutgers, EJT ;
Besnard, APE ;
Muller, SH ;
Gilhuijs, KGA .
EUROPEAN JOURNAL OF CANCER, 2005, 41 (10) :1393-1401
[7]  
DREW PJ, 2008, SAN ANT BREAST CANC
[8]   Overall breast density in MR mammography -: Diagnostic and therapeutic implications in breast cancer [J].
Echevarria, JJ ;
Martín, M ;
Saiz, A ;
Imaz, I ;
Férnandez-Ruanova, B ;
Martín, D ;
López-Ruiz, JA .
JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY, 2006, 30 (01) :140-147
[9]   Breast carcinoma: Effect of preoperative contrast-enhanced MR imaging on the therapeutic approach [J].
Fischer, U ;
Kopka, L ;
Grabbe, E .
RADIOLOGY, 1999, 213 (03) :881-888
[10]   Follow-up of patients with early breast cancer [J].
Hayes, Daniel F. .
NEW ENGLAND JOURNAL OF MEDICINE, 2007, 356 (24) :2505-2513