Meta-Analysis Indicates No Reduction in Risk of Local or Distant Breast Cancer Recurrence With Preoperative Staging MRI
In an individual patient data meta-analysis reported in the Journal of Clinical Oncology, Houssami et al found that preoperative magnetic resonance imaging (MRI) was not associated with differences in local recurrence or distant recurrence compared with conventional imaging in women with breast cancer.
Study Details
The study included data from four trials with comparative data on local recurrence in cohorts of breast cancer patients who had received preoperative conventional imaging only and those who had also received MRI. The studies included patients who were candidates for breast-conserving surgery, with the meta-analysis including patients in whom breast-conserving surgery was attempted but who ultimately received mastectomy.
The meta-analysis included data on 3,180 affected breasts in 3,169 patients, with 1,833 breasts (58%) being examined by MRI and 1,347 (42%) not being examined by MRI. Patients had a median age of 56 years, and median tumor size was 15.0 mm.
Local Recurrence
There was no significant difference between the MRI and no-MRI groups in 8-year local recurrence-free survival (97% vs 95%, P = .87). In a multivariate model including age, tumor grade, final margin status, and estrogen receptor status, there was no significant effect of MRI vs no MRI (hazard ratio [HR] = 0.88, P = .65); there was also no significant effect of MRI in a sensitivity analysis restricted to breast-conserving surgery (HR = 0.96, P = .90). Age, tumor grade, final margin status, and estrogen receptor status were all significant predictors of local recurrence-free survival in the multivariate model.
Distant Recurrence
There was no difference between the MRI and no-MRI groups in 8-year distant recurrence-free survival (89% vs 93%, P = .37). In a multivariate model including age, pathologic tumor size, tumor grade, node status, estrogen receptor status, surgery, and receipt of endocrine therapy or chemotherapy, there was also no significant effect of MRI in the full analysis (HR = 1.18, P = .48) or in the sensitivity analysis restricted to breast-conserving surgery (HR = 1.31, P = .34).
Significant predictors of distant recurrence-free survival were pathologic tumor size, tumor grade, node status, estrogen receptor status, surgery, and receipt of systemic therapy.
The investigators concluded, “Preoperative MRI for staging the cancerous breast does not reduce the risk of [local recurrence] or [distant recurrence]…. Clinicians using or recommending preoperative breast MRI should take into account that MRI does not reduce the risk of [local recurrence] or [distant recurrence] during clinical decision making and discussions with patients newly diagnosed with [breast cancer].”
Nehmat Houssami, MBBS, PhD, of University of Sydney, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported in part by a grant from the National Health and Medical Research Council Program. The study authors reported no potential conflicts of interest.
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