title: Preoperative magnetic resonance imaging in breast cancer: meta-analysis of surgical outcomes.
abstract: 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.
authors.affiliation: Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. nehmath@med.usyd.edu.au
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.forename: Robin
authors.initials: R
authors.lastname: Turner
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008408:Mastectomy / Q000706:statistics & numerical data; D009367:Neoplasm Staging / Q000379:methods; D057234:Preoperative Period; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome