title: Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: systematic review of diagnostic accuracy and meta-analysis.
abstract: OBJECTIVE
  To estimate the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting additional lesions and contralateral cancer not identified using conventional imaging in primary breast cancer.
  
  
  METHODS
  We have conducted a systematic review and meta-analyses to estimate diagnostic accuracy indices and the impact of MRI on surgical management.
  
  
  RESULTS
  Fifty articles were included (n = 10,811 women). MRI detected additional disease in 20% of women and in the contralateral breast in 5.5%. The summary PPV of ipsilateral additional disease was 67% (95% CI 59-74%). For contralateral breast, the PPV was 37% (95% CI 27-47%). For ipsilateral lesions, MRI devices ≥1.5 Tesla (T) had higher PPV (75%, 95% CI 64-83%) than MRI with <1.5 T (59%, 95% CI 53-71%). Similar results were found for contralateral cancer, PPV 40% (95% CI 29-53%) and 19% (95% CI 8-39%) for high- and low-field equipments, respectively. True positive MRI findings prompted conversion from wide local excision (WLE) to more extensive surgery in 12.8% of women while in 6.3% this conversion was inappropriate.
  
  
  CONCLUSIONS
  MRI shows high diagnostic accuracy, but MRI findings should be pathologically verified because of the high FP rate. Future research on this emerging technology should focus on patient outcome as the primary end-point.
authors.affiliation: Clinical Biostatistics Unit. Hospital Universitario Ramón y Cajal, CIBER en Epidemiología y Salud Pública (CIBERESP) and Instituto de Investigación Sanitaria (IRYCIS), Ctra. Colmenar km 9, 100 28034 Madrid, Spain.
authors.forename: María Nieves
authors.initials: MN
authors.lastname: Plana
authors.forename: Carmen
authors.initials: C
authors.lastname: Carreira
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Miguel
authors.initials: M
authors.lastname: Chiva
authors.forename: Víctor
authors.initials: V
authors.lastname: Abraira
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: Emparanza
authors.forename: Xavier
authors.initials: X
authors.lastname: Bonfill
authors.forename: Javier
authors.initials: J
authors.lastname: Zamora
mesh_terms: D001940:Breast / Q000473:pathology* / Q000601:surgery; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D057234:Preoperative Period; D012680:Sensitivity and Specificity