title: Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy.
abstract: BACKGROUND
  Magnetic resonance imaging (MRI) has been proposed to guide breast cancer surgery by measuring residual tumour after neoadjuvant chemotherapy. This study-level meta-analysis examines MRI's agreement with pathology, compares MRI with alternative tests and investigates consistency between different measures of agreement.
  
  
  METHODS
  A systematic literature search was undertaken. Mean differences (MDs) in tumour size between MRI or comparator tests and pathology were pooled by assuming a fixed effect. Limits of agreement (LOA) were estimated from a pooled variance by assuming equal variance of the differences across studies.
  
  
  RESULTS
  Data were extracted from 19 studies (958 patients). The pooled MD between MRI and pathology from six studies was 0.1 cm (95% LOA: -4.2 to 4.4 cm). Similar overestimation for MRI (MD: 0.1 cm) and ultrasound (US) (MD: 0.1 cm) was observed, with comparable LOA (two studies). Overestimation was lower for MRI (MD: 0.1 cm) than mammography (MD: 0.4 cm; two studies). Overestimation by MRI (MD: 0.1 cm) was smaller than underestimation by clinical examination (MD: -0.3 cm). The LOA for mammography and clinical examination were wider than that for MRI. Percentage agreement between MRI and pathology was greater than that of comparator tests (six studies). The range of Pearson's/Spearman's correlations was wide (0.21-0.92; 16 studies). Inconsistencies between MDs, percentage agreement and correlations were common.
  
  
  CONCLUSIONS
  Magnetic resonance imaging appears to slightly overestimate pathologic size, but measurement errors may be large enough to be clinically significant. Comparable performance by US was observed, but agreement with pathology was poorer for mammography and clinical examination. Percentage agreement can provide supplementary information to MDs and LOA, but Pearson's/Spearman's correlation does not provide evidence of agreement and should be avoided. Further comparisons of MRI and other tests using the recommended methods are warranted.
authors: Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, A27, Edward Ford Building, Camperdown, NSW 2006, Australia.
authors: M L
authors: ML
authors: Marinovich
authors: P
authors: P
authors: Macaskill
authors: L
authors: L
authors: Irwig
authors: F
authors: F
authors: Sardanelli
authors: G
authors: G
authors: von Minckwitz
authors: E
authors: E
authors: Mamounas
authors: M
authors: M
authors: Brennan
authors: S
authors: S
authors: Ciatto
authors: N
authors: N
authors: Houssami
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D011859:Radiography; D047368:Tumor Burden
references: Insights Imaging. 2013 Apr;4(2):163-75
references: 23359240
references: BMC Med Res Methodol. 2006 Mar 06;6:9
references: 16519814
references: J Natl Cancer Inst. 2013 Mar 6;105(5):321-33
references: 23297042
references: Br J Radiol. 2000 Oct;73(874):1031-3
references: 11271893
references: Int J Radiat Oncol Biol Phys. 2007 Sep 1;69(1):13-8
references: 17449193
references: J Surg Oncol. 2007 Nov 1;96(6):474-80
references: 17640031
references: Radiology. 2011 Jan;258(1):59-72
references: 21076089
references: Ann Surg Oncol. 2011 Aug;18(8):2150-7
references: 21301969
references: Breast. 2012 Oct;21(5):669-77
references: 22863284
references: Br J Cancer. 2008 Jan 29;98(2):289-93
references: 18219287
references: Eur J Cancer. 2010 May;46(8):1296-316
references: 20304629
references: Ann Intern Med. 2008 Dec 2;149(11):816-22
references: 19047029
references: Aust N Z J Surg. 1997 Nov;67(11):750-4
references: 9396988
references: Lancet. 1986 Feb 8;1(8476):307-10
references: 2868172
references: Eur J Cancer. 2009 Jan;45(2):228-47
references: 19097774
references: J Surg Oncol. 2010 Jun 1;101(7):604-10
references: 20461768
references: Cancer. 2009 Mar 15;115(6):1194-202
references: 19156919
references: Breast J. 2006 Mar-Apr;12(2):130-7
references: 16509837
references: Breast Cancer. 2011 Jul;18(3):152-60
references: 21086082
references: Eur J Surg Oncol. 2004 Dec;30(10):1069-76
references: 15522553
references: Eur Radiol. 2004 Aug;14(8):1371-9
references: 14986052
references: Breast. 2012 Oct;21(5):682-5
references: 22835917
references: Hum Pathol. 2005 Jul;36(7):756-60
references: 16084944
references: Breast Cancer Res Treat. 2004 Jun;85(3):211-8
references: 15111758
references: AJR Am J Roentgenol. 2005 Mar;184(3):868-77
references: 15728611
references: Eur Radiol. 2005 Jun;15(6):1224-33
references: 15906034
references: AJR Am J Roentgenol. 2003 Nov;181(5):1275-82
references: 14573420
references: Int J Breast Cancer. 2012;2012:171792
references: 23316372
references: Breast Cancer Res Treat. 2003 Mar;78(1):51-8
references: 12611457
references: Breast Cancer Res Treat. 2002 Mar;72(2):145-52
references: 12038705
references: J Magn Reson Imaging. 2001 Jun;13(6):868-75
references: 11382946
references: Eur J Surg Oncol. 2005 Dec;31(10):1129-34
references: 15905068
references: Ann Oncol. 2009 Apr;20(4):636-41
references: 19179551
references: Int J Clin Exp Pathol. 2010 Feb 22;3(3):303-9
references: 20224728
references: Clin Radiol. 2006 Nov;61(11):946-53
references: 17018307
references: NMR Biomed. 2011 Jul;24(6):712-20
references: 21692116
references: Acad Radiol. 2004 Oct;11(10):1115-24
references: 15530804
references: BMC Med Res Methodol. 2003 Nov 10;3:25
references: 14606960
references: AJR Am J Roentgenol. 2002 Nov;179(5):1193-9
references: 12388497
references: Comput Biol Med. 1990;20(5):337-40
references: 2257734
references: BMJ. 2003 Sep 6;327(7414):557-60
references: 12958120