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
- 20 November 2009
- journal article
- review article
- Published by American Society of Clinical Oncology (ASCO) in Journal of Clinical Oncology
- Vol. 27 (33), 5640-5649
- https://doi.org/10.1200/jco.2008.21.5756
Abstract
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.Keywords
This publication has 43 references indexed in Scilit:
- Magnetic resonance imaging in breast cancer: results of the COMICE trialBreast Cancer Research, 2008
- Accuracy and Surgical Impact of Magnetic Resonance Imaging in Breast Cancer Staging: Systematic Review and Meta-Analysis in Detection of Multifocal and Multicentric CancerJournal of Clinical Oncology, 2008
- Relationship of Breast Magnetic Resonance Imaging to Outcome After Breast-Conservation Treatment With Radiation for Women With Early-Stage Invasive Breast Carcinoma or Ductal Carcinoma in SituJournal of Clinical Oncology, 2008
- Using MRI to detect contralateral breast cancer.The Lancet Oncology, 2007
- MRI Evaluation of the Contralateral Breast in Women with Recently Diagnosed Breast CancerNew England Journal of Medicine, 2007
- Does preoperative magnetic resonance imaging modify breast cancer surgery?Acta Chirurgica Belgica, 2007
- The impact of bilateral breast cancer on the prognosis of breast cancer: a comparative study with unilateral breast cancerBreast Cancer, 2005
- MR Imaging Screening of the Contralateral Breast in Patients with Newly Diagnosed Breast Cancer: Preliminary ResultsRadiology, 2003
- The long-term outcome of synchronous bilateral breast cancer is worse than metachronous or unilateral tumoursEuropean Journal of Surgical Oncology, 2002
- Prognostic significance of synchronous and metachronous bilateral breast cancerWorld Journal of Surgery, 2001