Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests: individual patient data meta-analysis

BMC Cancer

Research Article

Madhumita Bhattacharyya¹  Eren Yeh²  Savannah C. Partridge³  Francesco Sardanelli⁴  Laura Martincich⁵  Frances C. Wright⁶  Gunter von Minckwitz⁷  Viviana Londero⁸  Eleftherios Mamounas⁹  Jae Hyuck Choi^1,10  Les Irwig^1,11  Petra Macaskill^1,11  Michael L. Marinovich^1,11  Nehmat Houssami^1,11  Valentina Guarneri^1,12 

[1] Berkshire Cancer Centre, Royal Berkshire NHS Foundation Trust, London Road, RG1 5AN, Reading, UK;Department of Radiology, Brigham and Women’s Hospital, 75 Francis St, 02115, Boston, MA, USA;Department of Radiology, University of Washington, 825 Eastlake Ave E, G3-200, 98109-1023, Seattle, WA, USA;Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Unità di Radiologia, IRCCS Policlinico San Donato, Piazza E. Malan 2, San Donato Milanese, Milano, Italy;Direzione Radiodiagnostica, Fondazione del Piemonte per l’Oncologia-IRCCS, Str. Prov.142, Candiolo, Torino, Italy;Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, M4C 5T2, Toronto, ON, Canada;German Breast Group & Universitäts-Frauenklinik Frankfurt, Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany;Institute of Radiology, University of Udine, p.le S.M. della Misericordia, 15, 33100, Udine, Italy;MD Anderson Cancer Center Orlando, 1400 South Orange Avenue, MP 700, 32806, Orlando, FL, USA;School of Medicine, Jeju National University Hospital, Aran 13gil 15(ara-1 dong), Jeju-si, Jeju-do, South Korea;Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, A27, Edward Ford Building, 2006, Sydney, NSW, Australia;University of Padova, Division of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy;

关键词: Breast cancer;    Neoadjuvant chemotherapy;    Magnetic resonance imaging;    Tumor response;    Monitoring;   

DOI  :  10.1186/s12885-015-1664-4

 received in 2015-02-24, accepted in 2015-09-29,  发布年份 2015

来源: Springer

【 摘 要 】

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 Abstracts 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.

【 授权许可】

CC BY   
© Marinovich et al. 2015