Preoperative MRI staging shows no risk reduction of breast cancer recurrence

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1. Preoperative magnetic resonance imaging (MRI) in breast cancer did not significantly affect local or distal recurrent breast cancer in a meta-analysis of 4 studies.

Evidence rating level: 2 (Good)

Study Rundown: There is currently a great deal of uncertainty regarding the use of MRI in staging newly diagnosed breast cancer in women, particularly in the preoperative setting. A few studies have investigated the long-term effect of MRI on in-breast recurrence, with most studies finding no association. However, given the limited statistical power of single studies, the goal of this meta-analysis was to more definitively examine the association between preoperative MRI and local and distal recurrence in women treated for breast cancer.

In total, four eligible studies contributed data to this analysis. The authors found that eight-year local recurrence free survival did not differ between the MRI and non-MRI groups, nor was any difference found in sensitivity analysis. As a secondary outcome, the authors’ multivariable model showed no significant effect of MRI on distal recurrence free survival. Based on these findings, the authors concluded that preoperative staging MRI in breast cancer does not reduce the risk of recurrence. They also suggest that additional disease detected only by MRI is inconsequential. These conclusions are supported by many strengths of this study, including its large scale with a relatively large number of events, use of IPD and multivariate analysis for confounding, and use of sensitivity analysis. However, it should be noted that this meta-analysis only included four studies, with relatively modest follow-up, and that three of the included studies were non-randomized. Furthermore, it is possible that associations between staging MRI and recurrence may be found with longer follow-up.

Click to read the article in JCO

Relevant reading: Review of preoperative magnetic resonance imaging (MRI) in breast cancer: Should MRI be performed in all women with newly diagnosed, early stage breast cancer?

In-Depth [individual person data meta-analysis]: This was an individual person data (IPD) meta-analysis using data from published studies that compared cohorts of female breast cancer patients who received preoperative assessment with conventional imaging versus conventional imaging in addition to preoperative MRI. To be eligible, studies had to have reported comparative data on local recurrence as a primary outcome. All modes of surgical treatment for breast cancer were included, and minimum follow-up calculated from date of surgery was 90 days. Ultimately, four eligible studies contributed data on 3180 affected breasts in 3169 patients. One study was a randomized controlled trial, and three were non-randomized studies. There was a median follow-up of 2.9 years. Survival analysis was used to investigate time to local recurrence and to estimate the hazard ratio for MRI.

Upon analysis, the authors found that eight-year modeled local recurrence free survival did not differ between the MRI (97%) and non-MRI (95%) groups (p = 0.87). There was no significant effect of MRI on LR-free survival, with a hazard ratio of 0.88 (95% CI, 0.52 to 1.41; p = 0.65), though age, margin status, and tumor grade were all associated with LR-free survival (p < 0.05). The HR for MRI was 0.96 (95% CI, 0.52 to 1.77, p = 0.90). Furthermore, eight year distal recurrence free survival did not differ between the MRI (0.89%) and non-MRI (93%) groups, with the HR for MRI 1.18 (95% CI, 0.76 to 2.27; p = 0.48).

By Monica Parks and Andrew Bishara

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