1. Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)
- Author
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Miranda Langedam, Pablo Alonso-Coello, Jessica Hanae Zafra-Tanaka, Zuleika Saz-Parkinson, Carlos Canelo-Aybar, Axel Graewingholt, Annette Lebeau, Elena Parmelli, Paolo Giorgi Rossi, Alvaro Taype-Rondan, Margarita Posso, Elsa Pérez Gómez, and David Rigau
- Subjects
medicine.medical_specialty ,Population ,Breast Neoplasms ,Cochrane Library ,Mastectomy, Segmental ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Magnetic resonance imaging ,Breast cancer ,0302 clinical medicine ,medicine ,Breast MRI ,Humans ,Radiology, Nuclear Medicine and imaging ,Breast ,education ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Ductal carcinoma in situ ,General Medicine ,Odds ratio ,medicine.disease ,Magnetic Resonance Imaging ,Clinical trial ,Carcinoma, Intraductal, Noninfiltrating ,030220 oncology & carcinogenesis ,Relative risk ,Female ,Radiology ,Neoplasm Recurrence, Local ,business ,Cohort study - Abstract
Objective To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0.95, 95% CI 0.90 to 1.00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0.96; 95% CI 0.36 to 2.61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0.91; 95% CI 0.65 to 1.27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1.18; 95% CI 0.79 to 1.76) (very low certainty). Conclusion We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.
- Published
- 2020