Impact of Preoperative Magnetic Resonance Imaging on Surgical Outcomes in Women with Invasive Breast Cancer: A Systematic Review and Meta-Analysis

Abstract

Background. Currently, whether magnetic resonance imaging (MRI) should be routinely applied to patients with breast cancer before surgery remains controversial. A pooled analysis of the association between preoperative MRI and surgical outcomes in female patients with newly diagnosed invasive breast cancer was conducted to provide evidence-based medicine for clinical practice. Methods. Three independent researchers searched the following databases: PubMed, Medline, Embase, Ovid, Cochrane Library, and Web of Science from inception to April 2022. Literature was included and excluded according to Cochrane’s principles. The basic information from eligible documents was extracted. Systematic evaluation and meta-analysis were performed, and the odds ratio (OR) was analyzed by the random-effect model. The quality of the literature was assessed using the modified Jadad scale and the Newcastle-Ottawa (NOS) mean scale. Results. A total of 19 studies were included, including 4 randomized controlled trials and 15 observational comparative studies. Among them, most studies were not limited to a specific pathological type, with the exception of 3 that were limited to invasive lobular carcinoma. The results showed that preoperative MRI examination would significantly reduce the reoperation rate (OR = 0.77, P = 0.02 ) and increase the mastectomy rate (OR = 1.36, P = 0.001 ). In comparison, preoperative MRI did not significantly affect the rate of secondary mastectomy (OR = 0.77, P = 0.02 ), the rate of positive margin (OR = 1.08, P = 0.66 ), the rate of mastectomy (OR = 1.00, P < 0.05 ), and reoperations (OR = 0.65, P = 0.19 ) in the subgroup analysis of patients with invasive lobular carcinoma. Conclusion. Available evidence suggests that preoperative MRI examination increases the rate of mastectomy and reduces the rate of reoperations. The results indicate that preoperative MRI examination has the potential to benefit patients with breast cancer, but more high-quality studies are needed for confirmation.

Local Recurrence After Breast-Conserving Therapy in Patients With Multiple Ipsilateral Breast Cancer: Results From ACOSOG Z11102 (Alliance)

“…Use of MRI does carry potential risk as it has a significant false-positive rate, incurs cost, and has been shown to increase rate of mastectomy. 25-28…”

“…Use of MRI does carry potential risk as it has a significant false-positive rate, incurs cost, and has been shown to increase rate of mastectomy. [25][26][27][28] The initial Z11102 protocol required preoperative MRI, and in May 2015, an amendment made patients without a preoperative MRI eligible. Only 15 patients on the trial did not have an MRI; however, three of the six LRs occurred in this group, resulting in a significantly higher 5-year LR rate in the small cohort of patients without preoperative breast MRI.…”