Abstract
BackgroundMagnetic resonance imaging (MRI) may guide breast cancer surgery by measuring residual tumor size post-neoadjuvant chemotherapy (NAC). Accurate measurement may avoid overly radical surgery or reduce the need for repeat surgery. This individual patient data (IPD) meta-analysis examines MRI’s agreement with pathology in measuring the longest tumor diameter and compares MRI with alternative tests.MethodsA systematic review of MEDLINE, EMBASE, PREMEDLINE, Database of s of Reviews of Effects, Heath Technology Assessment, and Cochrane databases identified eligible studies. Primary study authors supplied IPD in a template format constructed a priori. Mean differences (MDs) between tests and pathology (i.e. systematic bias) were calculated and pooled by the inverse variance method; limits of agreement (LOA) were estimated. Test measurements of 0.0 cm in the presence of pathologic residual tumor, and measurements >0.0 cm despite pathologic complete response (pCR) were described for MRI and alternative tests.ResultsEight studies contributed IPD (N = 300). The pooled MD for MRI was 0.0 cm (LOA: +/−3.8 cm). Ultrasound underestimated pathologic size (MD: −0.3 cm) relative to MRI (MD: 0.1 cm), with comparable LOA. MDs were similar for MRI (0.1 cm) and mammography (0.0 cm), with wider LOA for mammography. Clinical examination underestimated size (MD: −0.8 cm) relative to MRI (MD: 0.0 cm), with wider LOA. Tumors “missed” by MRI typically measured 2.0 cm or less at pathology; tumors >2.0 cm were more commonly “missed” by clinical examination (9.3 %). MRI measurements >5.0 cm occurred in 5.3 % of patients with pCR, but were more frequent for mammography (46.2 %).ConclusionsThere was no systematic bias in MRI tumor measurement, but LOA are large enough to be clinically important. MRI’s performance was generally superior to ultrasound, mammography, and clinical examination, and it may be considered the most appropriate test in this setting. Test combinations should be explored in future studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1664-4) contains supplementary material, which is available to authorized users.
Highlights
Magnetic resonance imaging (MRI) may guide breast cancer surgery by measuring residual tumor size post-neoadjuvant chemotherapy (NAC)
Underestimation of tumor size may lead to involved surgical margins and repeat surgery; overestimation may lead to overly radical surgery, and poorer cosmetic and psychosocial outcomes [3]
We investigated agreement between MRI-measured and pathologic tumor size after NAC in an individual patient data (IPD) metaanalysis of a large number of breast cancer patients, using appropriate methods for evaluating the agreement between measurements [15]
Summary
Magnetic resonance imaging (MRI) may guide breast cancer surgery by measuring residual tumor size post-neoadjuvant chemotherapy (NAC). Accurate measurement may avoid overly radical surgery or reduce the need for repeat surgery. This individual patient data (IPD) meta-analysis examines MRI’s agreement with pathology in measuring the longest tumor diameter and compares MRI with alternative tests. Magnetic resonance imaging (MRI) has been proposed to have a role in guiding breast cancer surgery by measuring the size of residual tumor after neoadjuvant chemotherapy (NAC), and has been shown to have high sensitivity for detecting residual disease [1]. Underestimation of tumor size may lead to involved surgical margins and repeat surgery; overestimation may lead to overly radical surgery (including mastectomy when BCS may have been possible), and poorer cosmetic and psychosocial outcomes [3]. The effects of NAC may introduce greater bias in residual tumor measurement relative to the preoperative setting: reactive inflammation, fibrosis or necrosis may be difficult to distinguish from residual tumor [13], and measurement errors may be additive when tumors regress as multiple, scattered deposits [2]
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