Preoperative Magnetic Resonance Imaging in Breast Cancer Meta-Analysis of Surgical Outcomes
Preoperative Magnetic Resonance Imaging in Breast Cancer Meta-Analysis of Surgical Outcomes
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DOI：
10.1097/sla.0b013e31827a8d17
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发表时间：
2013-02-01
影响因子：
9
通讯作者：
Morrow, Monica
中科院分区：
文献类型：
--
作者：
Houssami, Nehmat;Turner, Robin;Morrow, Monica
背景和目的：乳房磁共振成像(MRI)在新诊断为乳腺癌(BC)的女性中的作用存在争议。这项荟萃分析检验了术前MRI和标准术前评估对手术结果的影响，重点研究了使用对照设计的研究。方法：使用随机效应Logistic Meta回归模型，我们估计了MRI组和非MRI组中每个结果的女性比例，并计算了每个模型的优势比(OR)和调整后的OR(在适当的情况下，调整了研究水平的中位年龄，并在适当的情况下调整了时间效应)。结果：共有9项合格研究(2项随机试验；7个比较队列)。在3112例乳腺癌(任何组织学类型)患者中，MRI检查与非MRI检查的结果分别为：初次乳房切除术16.4%比8.1%[OR2.22(P<；0.001)；调整OR3.06(P<；0.001)]；初次保乳后再切除11.6%比11.4%[OR1.02(P=0.87)；调整OR0.95(P=0.71)]；总乳房切除25.5%与18.2%[OR，1.54(P<；0.001)；调整OR，1.51(P<；0.001)]。结果：初次乳房切除31.1%与24.9%[OR1.36(P=0.056)；调整后OR2.12(P=0.008)]，初次保乳再切除10.9%与18.0%[OR0.56(P=0.031)；调整OR0.56(P=0.09)]，全乳切除43.0%与40.2%[OR1.12(P=0.45)]；调整后的OR1.64(P=0.034)]。结论：我们的证据总结显示核磁共振显著增加了乳腺癌的切除率，并提示常规使用核磁共振在结直肠癌手术前的伤害-收益比是不利的。我们发现，MRI减少了ILC患者的再次切除手术的证据很弱--尽管这是以增加乳房切除术为代价的--从这项研究中还不清楚MRI对ILC患者的整体益处。
Background and Objective: 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.Methods: 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.Results: 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)].Conclusions: 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.