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Magnetic resonance imaging in the preoperative assessment of patients with primary breast cancer: Systematic review of diagnostic accuracy and meta-analysis

机译：磁共振成像在原发性乳腺癌患者术前评估中的应用：诊断准确性和荟萃分析的系统评价

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Objectives 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.
机译：目的评估磁共振成像（MRI）在原发性乳腺癌中检测常规成像未发现的其他病变和对侧癌的诊断准确性。方法我们进行了系统的回顾和荟萃分析，以评估诊断准确性指标以及MR​​I对手术管理的影响。结果纳入50篇文章（n = 10,811名女性）。 MRI在20％的女性和5.5％的对侧乳腺中发现了其他疾病。同侧其他疾病的概要PPV为67％（95％CI 59-74％）。对于对侧乳房，PPV为37％（95％CI 27-47％）。对于同侧病变，≥1.5 Tesla（T）的MRI设备的PPV（75％，95％CI 64-83％）比<1.5 T的MRI（59％，95％CI 53-71％）高。对侧癌症的结果相似，高场和低场设备的PPV分别为40％（95％CI 29-53％）和19％（95％CI 8-39％）。真正的MRI阳性结果促使12.8％的女性从广泛的局部切除术（WLE）转换为更广泛的手术，而在6.3％的女性中，这种转换是不合适的。结论MRI具有较高的诊断准确性，但由于FP率较高，因此应在病理上证实MRI表现。对该新兴技术的未来研究应将患者的治疗结果作为主要终点。

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