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Preoperative MRI for breast cancer did not reduce risk for local, distant recurrence
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Preoperative MRI for staging newly diagnosed breast cancer did not diminish the risk for local or distant recurrence, according to results of a meta-analysis.
Nehmat Houssami, MBBS, FAFPHM, FASBP, MPH, PhD, associate professor at Sydney Medical School at the University of Sydney in Australia, and colleagues evaluated data culled from four published studies that included data on 3,169 patients. Of them, 1,833 (57.6%) had not received MRI and 1,347 (42.4%) had undergone MRI.
Local recurrence served as the primary outcome measure, and distant recurrence was a secondary outcome.
The researchers used survival analysis to evaluate time to local recurrence and calculate the HR for MRI. They utilized a series of models to evaluate the univariable relationship between local recurrence and preoperative MRI, along with possible confounding variables. The researchers also evaluated possible relationships between MRI and age, margins and tumor histology.
The researchers found no difference in 8-year local recurrence-free survival between the MRI group and the non-MRI group (97% vs. 95%; P=.87). The multivariable model also showed no significant effect of MRI on local recurrence-free survival (HR=.088 for MRI vs. no MRI; 95% CI, 0.52-1.51). The investigators did observe a correlation between local recurrence-free survival and age, margin and tumor histology (P<.05 for all). Sensitivity analysis found that the HR for MRI was 0.96 (95% CI, 0.52-1.77).
Similarly, results showed no significant difference in 8-year distant recurrence-free survival between the MRI and non-MRI groups (89% vs. 93%; P=.37). The multivariable model did not reveal a significant effect of MRI on distant recurrence-free survival (HR=1.18 for MRI vs. no MRI; 95% CI, 0.76-2.27).
Richard J. Bleicher
“At this point we must acknowledge that the routine use of preoperative breast MRI has demonstrated neither surgical or outcomes benefits,” Richard J. Bleicher, MD, of Fox Chase Cancer Center in Philadelphia, wrote in an accompanying editorial. “Although not a prospective study, the meta-analysis by Houssami et al adds strength to a growing body of data that suggests that we are unlikely to ever see such improvement in outcomes by using the modality routinely in the nonhigh-risk preoperative setting. We must therefore move forward by focusing on its use for entities such as Paget’s disease, occult primaries, and in deleterious BRCA mutation carriers, where it has been demonstrated to be definitively advantageous.”
Disclosure: The researchers and Bleicher report no relevant financial disclosures.
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