Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis

Plana, María Nieves; Carreira, C.; Muriel, Alfonso; Chiva, Miguel; Abraira, Víctor; Emparanza, José Ignacio; Bonfill, Xavier; Zamora, Javier

doi:10.1007/s00330-011-2238-8

Cited by 186 publications

(139 citation statements)

References 70 publications

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“…COMICE trial detected 16% of multifocal tumors 13 . The contralateral tumor rates found in our series were similar to other series 23,[27][28][29] . From the additional lesions suspect of malignancy detected through MRI, 68% were positive on the anatomopathological exam.…”

Section: Discussionsupporting

confidence: 92%

Impact of preoperatory magnetic resonance imaging in oncoplastic surgery

Anselmi¹,

Úrban²,

Urban³

et al. 2017

Rev. Bras. Mastol. (Impr.)

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Objetivo: Não há dados sobre o impacto da imagem de ressonância magnética (RM) na cirurgia oncoplástica. O objetivo deste trabalho foi avaliar o impacto da RM no planejamento cirúrgico e nas mudanças de conduta em pacientes com câncer de mama inicial e candidatas a realizar a cirurgia oncoplástica. Métodos: Trata-se de uma coorte prospectiva de 60 pacientes que foram candidatas à cirurgia oncoplástica entre janeiro de 2013 e julho de 2014. Todos elas foram submetidas a uma RM pré-operatória, além de mamografia (MG) e ultrassom (US). Qualquer tumor adicional na RM classificada como BIRADS 4-5 foi biopsiado ou marcado com carvão e ROLL para serem localizados durante a cirurgia. O impacto cirúrgico dos achados adicionais da RM foi avaliado quanto a mudanças para mastectomia ou ressecção mais ampla. Resultados: Das pacientes, 29/60 (48,3%) apresentaram achados adicionais na ressonância magnética, 16/29 (55%) foram tumores multifocais, 1/29 (3,4%) foi multicêntrico, 5/29 (17%) foram tumores contralaterais e 9/29 (31%) apresentaram tamanho de tumor maior que 10 mm na RM. Das 22 pacientes que apresentaram lesões adicionais na RM, 15 (68,2%) apresentaram carcinomas invasivos no exame anatomopatológico definitivo. A sensibilidade da RM foi maior na estimativa do tamanho do tumor. Das pacientes, 12/60 (20%) foram submetidas à mastectomia e 17/60 (28,3%) a ressecções mais amplas. Apenas 5% das pacientes apresentaram margens positivas em todo o grupo. No grupo de pacientes que apresentaram resultados adicionais na RM, apenas 3,4% tiveram margens positivas. Conclusões: A RM é melhor que a MG e o US na avaliação da extensão do tumor e na detecção de tumores multicêntricos, multifocais e bilaterais. Em consequência, contribuiu nesta série para um melhor planejamento cirúrgico na cirurgia oncoplástica com baixa taxa de margens comprometidas e reexcisão. PALAVRAS-CHAVE:Câncer de mama; imagem por ressonância magnética; cirurgia. RESUMO ABSTRACTObjective: There is no data about magnetic resonance image (MRI) impact in oncoplastic surgery (OP). The objective of this study was to evaluate the impact of MRI on the surgical planning and the changes of conduct in patients with initial breast cancer and candidates to perform the OP. Methods: This is a prospective cohort of 60 patients who were candidates to OP between January 2013 and July 2014. All of them underwent to a preoperative MRI, in addition to mammography (MG) and ultrasound (US). Any additional tumor in the MRI classified as BIRADS 4-5 were biopsied or marked with carbon and radiotracer in order to be localized during the surgery. Surgical impact of additional MRI findings were evaluated as to changes of approach to mastectomy or to wider resection. Results: Of the patients, 29/60 (48.3%) had additional findings on MRI, 16/29 (55%) were multifocal tumors, 1/29 (3.4%) was multicentric, 5/29 (17%) were contralateral tumors, and 9/29 (31%) presented tumor size larger than 10 mm in the MRI. Of 22 patients who showed additional lesions on MRI, 15 (68.2%) had invasive carcinomas i...

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Section: Discussionsupporting

confidence: 92%

Impact of preoperatory magnetic resonance imaging in oncoplastic surgery

Anselmi¹,

Úrban²,

Urban³

et al. 2017

Rev. Bras. Mastol. (Impr.)

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“…[16][17][18] We found that the ICDRs using BWBUS and DCE MRI significantly increased for ER-positive and triple-negative index cancers, but not for HER2-positive index cancers, compared with the ICDRs using mammography. This finding contrasts with a recent study reporting that pre-operative MRI may benefit patients with HER2-positive tumours most, as there is an increased likelihood of the presence of additional disease.…”

Section: Discussionmentioning

confidence: 70%

“…[4][5][6][7][8][9][10][11][12][13][14][15] Systematic reviews of the literature found that pre-operative MRI detected additional ipsilateral disease in 16-20% of patients and occult synchronous contralateral cancer in 4-5% of patients. [16][17][18] Despite the widespread use of breast MRI for pre-operative staging in recent years, this use remains controversial. There is a lack of evidence of long-term benefits from routine breast MRI for pre-operative staging.…”

Section: Introductionmentioning

confidence: 99%

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

He¹,

Plaxco²,

Wei³

et al. 2016

BJR

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Objective: To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer. Methods: A retrospective database search in a single institution identified 259 patients with breast cancer diagnosed from January 2011 to August 2014 who underwent mammography, BWBUS and MRI before surgery. Patient characteristics, tumour characteristics and lesions seen on each imaging modality were recorded. The sensitivity, specificity and accuracy for each modality were calculated. ICDRs according to index tumour histology and receptor status were also evaluated. The effect of additional cancer detection on surgical planning was obtained from the medical records. Results: A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p 5 0.01), while BWBUS was significantly more accurate and specific than MRI (p , 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptorpositive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients. Conclusion: MRI was more sensitive than BWBUS, while BWBUS was more accurate and specific than MRI. MRIdetected additional malignant lesions did not change surgical planning in almost half of these patients. Advances in knowledge: BWBUS may be a cost-effective and practical tool in breast cancer staging.

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“…12 A recently published meta-analysis confirmed these data, showing similar percentages (12% and 3%, respectively) based on a larger number of studies. 18 Asian breast density is known to be greater than in Caucasians, which is evident on both physical examination and imaging. 15,16 Moreover, MRI further enhances the distinction between normal and diseased breast tissue.…”

Section: Discussionmentioning

confidence: 99%

Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery

Law

Cheung²,

Lau³

et al. 2013

Hong Kong Med J

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ResultsThe most common indication for breast magnetic resonance imaging was the presence of multiple indeterminate shadows on ultrasound scans (53%), followed by ill-defined border of the main tumour on ultrasound scans (19%). In 66% (97 out of 147) of the patients, the extent of the operation was upgraded. Upgrading entailed: lumpectomy to wider lumpectomy (23 out of 97), lumpectomy to mastectomy (47 out of 97), lumpectomy to bilateral lumpectomy (15 out of 97), and other (12 out of 97). Mostly, these management changes were because magnetic resonance imaging showed more extensive disease (n=29), additional cancer foci (n=39), or contralateral disease (n=24). In five instances, upgrading was due to patient preference. In 34% (50 out of 147) of the patients, there was no change in the planned operation. Regarding 97 of the patients having altered management, in 12 the changes were considered inappropriately extensive (due to false-positive magnetic resonance imaging findings). In terms of magnetic resonance imaging detection of more extensive, multifocal, multicentric, or contralateral disease, the false-positive rate was 13% and false-negative rate 7%. Corresponding rates for sensitivity and specificity were 95% and 81%, using the final pathology as the gold standard.Conclusions Preoperative magnetic resonance imaging had a clinically significant and mostly correct impact on management plans. Magnetic resonance imaging should be included as part of the preoperative investigation in patients planned for breastconserving surgery, in whom there are doubts about the extent of the tumours based on conventional assessment. • MRI demonstrated high sensitivity and moderate specificity in detecting additional cancer foci. Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery O R I G I N A L A R T I C L E Implications for clinical practice or policy• Preoperative MRI should be considered in patients with suspected additional disease foci or indeterminate tumour margins, in addition to conventional imaging by mammography and ultrasonography. CME # Preoperative planning for breast cancer surgery #

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Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis

Abstract: MRI shows high diagnostic accuracy, but MRI findings should be pathologically verified because of the high FP rate. Future research on this emerging technology should focus on patient outcome as the primary end-point.

Cited by 186 publications

References 70 publications

Impact of preoperatory magnetic resonance imaging in oncoplastic surgery

Impact of preoperatory magnetic resonance imaging in oncoplastic surgery

Incremental cancer detection using breast ultrasonographyversusbreast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients

Impact of magnetic resonance imaging on preoperative planning for breast cancer surgery

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