Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Ann Surg. 2013 Feb;257(2):249-55. doi: 10.1097/SLA.0b013e31827a8d17.
The role of breast magnetic resonance imaging (MRI) in women newly diagnosed with breast cancer (BC) is controversial. This meta-analysis examines the effect of preoperative MRI compared with standard preoperative assessment on surgical outcomes, focusing on studies that used a controlled design.
Using random-effects logistic meta-regression modeling, we estimated the proportion of women with each outcome in the MRI versus no-MRI groups, and calculated the odds ratio (OR) and adjusted OR (adjusted for study-level median age, and, where appropriate, for temporal effect) for each model.
There were 9 eligible studies (2 randomized trials; 7 comparative cohorts). Outcomes in 3112 patients with BC (any histological tumor type) for MRI versus no-MRI (referent) were as follows: initial mastectomy 16.4% versus 8.1% [OR, 2.22 (P < 0.001); adjusted OR, 3.06 (P < 0.001)]; re-excision after initial breast conservation 11.6% versus 11.4% [OR, 1.02 (P = 0.87); adjusted OR, 0.95 (P = 0.71)]; overall mastectomy 25.5% versus 18.2% [OR, 1.54 (P < 0.001); adjusted OR, 1.51 (P < 0.001)]. In 766 patients with invasive lobular cancer (ILC), outcomes were as follows: initial mastectomy 31.1% versus 24.9% [OR, 1.36 (P = 0.056); adjusted OR, 2.12 (P = 0.008)]; re-excision after initial breast conservation 10.9% versus 18.0% [OR, 0.56 (P = 0.031); adjusted OR, 0.56 (P = 0.09)]; overall mastectomy 43.0% versus 40.2% [OR, 1.12 (P = 0.45); adjusted OR, 1.64 (P = 0.034)].
Our summary of the evidence showed that MRI significantly increased mastectomy rates and suggests an unfavorable harm-benefit ratio for routine use of preoperative MRI in BC. We found weak evidence that MRI reduced re-excision surgery in patients with ILC -although this was at the expense of increased mastectomies-and overall patient benefit from MRI in ILC is not clear from this study.
新诊断乳腺癌（BC）女性中乳腺磁共振成像（MRI）的作用存在争议。本荟萃分析着眼于使用对照设计的研究，探讨了术前 MRI 与标准术前评估相比对手术结果的影响。
我们使用随机效应逻辑荟萃回归模型，估计了 MRI 组与无 MRI 组中每种结局的女性比例，并计算了每个模型的优势比（OR）和调整后的 OR（按研究水平中位数年龄进行调整，在适当的情况下，按时间效应进行调整）。
有 9 项符合条件的研究（2 项随机试验；7 项比较队列）。3112 例 BC（任何组织学肿瘤类型）患者的 MRI 与无 MRI（参考）结果如下：初始乳房切除术 16.4%比 8.1%[OR，2.22（P<0.001）；调整后 OR，3.06（P<0.001)]；初始保乳术后再次切除术 11.6%比 11.4%[OR，1.02（P=0.87）；调整后 OR，0.95（P=0.71)]；总乳房切除术 25.5%比 18.2%[OR，1.54（P<0.001）；调整后 OR，1.51（P<0.001)]。在 766 例浸润性小叶癌（ILC）患者中，结果如下：初始乳房切除术 31.1%比 24.9%[OR，1.36（P=0.056）；调整后 OR，2.12（P=0.008)]；初始保乳术后再次切除术 10.9%比 18.0%[OR，0.56（P=0.031）；调整后 OR，0.56（P=0.09)]；总乳房切除术 43.0%比 40.2%[OR，1.12（P=0.45）；调整后 OR，1.64（P=0.034)]。
我们对证据的总结表明，MRI 显著增加了乳房切除术的比例，并表明 BC 中常规使用术前 MRI 的危害-效益比不利。我们发现微弱的证据表明 MRI 减少了 ILC 患者的再次切除术-尽管这是以增加乳房切除术为代价的-并且从这项研究中尚不清楚 MRI 是否对 ILC 患者整体有益。
