Meta-analysis Of The Association Between Preoperative MRI And Surgical Outcomes In Breast Cancer

ObjectiveTo systematically evaluate the association between preoperative MRI and surgical outcomes that include mastectomy rate,breast conservation rate and re-excision rate.MethodsA systematic literature search was performed using the Wan fang,PubMed,Cochrane Library,Embase and Vip,from database establishment to December 2018,to identify studies reporting surgical outcomes of preoperative MRI in patients diagnosed with breast cancer,using the following keywords:"breast cancer","magnetic resonance imaging","mastectomy rate","re-excision rate"and"breast conservation rate".the data of mastectomy rate,breast conservation rate and re-excision rate were extracted from the two groups in the MRI group versus no-MRI group.Selected studies must fulfil a set of inclusion criteria as following:(1)prospective randomized clinical trials;(2)breast cancer must be clearly diagnosed by pathological examination,including invasive carcinoma,intraductal carcinoma in situ;(3)articles published up to December 2018;(4)English or Chinese articles;(5)sample size is greater than or equal to 100 cases;(6)direct or indirect access to the data of mastectomy rate,breast conservation rate and re-excision rate.Exclusion criteria:(1)articles of abstracts,reviews,retrospective studies,or case reports;(2)studies without control group;(3)sample size is less than 100 cases;(4)multiple articles published by the same authors,selected the one with best quality;(5)incomplete data.Odds ratios(OR)of each outcome were calculated for each study.Statistical heterogeneity among the studies was evaluated with Q test and I~2 statistic.At the same time,a funnel plot was used to assess reporting bias.Review manager5.3 was used for meta-analysis.We assessed the risk of bias of each article included with the tool recommend by the Cochrane Collaboration.Results4 RCTs met eligibility criteria that include totally 2312 patients.We assessed the risk of bias of each article included with the tool recommend by the Cochrane Collaboration.The overall results showed a low risk of bias,and the funnel plot suggested that the study bias was not significant.Analysis results of MRI group versus no-MRI group were as follows:mastectomy rate 15%vs 10%,OR 2.01,95%CI 0.79-5.11,P=0.14.Breast conservation rate 84%vs 89%,OR 0.58,95%CI0.29-1.17,P=0.13.Re-excision rate 17%vs 19%,OR 0.76,95%CI 0.37-1.54,P=0.45.The analysis showed that there was no significant difference between the MRI group and the no MRI group in surgical outcomes that include mastectomy rate,breast conservation rate and re-excision rate.ConclusionsEvidences showed that there was no significant association between preoperative MRI and surgical outcomes that include mastectomy rate,breast conservation rate and re-excision rate.The benefits of preoperative MRI in patients with breast cancer are not significant,but may increase medical costs.