Preoperative breast magnetic resonance imaging in patients with ductal carcinoma in situ : a systematic review for the European Commission Initiative on Breast Cancer (ECIBC)
Canelo Aybar, Carlos Gilberto (Institut d'Investigació Biomèdica Sant Pau)
Taype-Rondan, Álvaro (Universidad San Ignacio de Loyola. Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud)
Zafra-Tanaka, Jessica (CRONICAS Centre of Excellence in Chronic Diseases. Universidad Peruana Cayetano Heredia)
Rigau, David (Institut d'Investigació Biomèdica Sant Pau)
Graewingholt, Axel (Radiologie am Theater)
Lebeau, Annette (University Medical Center Hamburg-Eppendorf. Institute of Pathology)
Pérez Gómez, Elsa (Hospital Universitari de Girona Doctor Josep Trueta)
Giorgi Rossi, Paolo (Azienda USL - IRCCS di Reggio Emilia)
Langendam, Miranda (University of Amsterdam)
Posso, Margarita (Institut Hospital del Mar d'Investigacions Mèdiques)
Parmelli, Elena (European Commission. Joint Research Centre (JRC))
Saz-Parkinson, Zuleika (European Commission. Joint Research Centre (JRC))
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)

Data:	2021
Resum:	Objective: To evaluate the impact of preoperative MRI in the management of Ductal carcinoma in situ (DCIS). Methods: We searched the PubMed, EMBASE and Cochrane Library databases to identify randomised clinical trials (RCTs) or cohort studies assessing the impact of preoperative breast MRI in surgical outcomes, treatment change or loco-regional recurrence. We provided pooled estimates for odds ratios (OR), relative risks (RR) and proportions and assessed the certainty of the evidence using the GRADE approach. Results: We included 3 RCTs and 23 observational cohorts, corresponding to 20,415 patients. For initial breast-conserving surgery (BCS), the RCTs showed that MRI may result in little to no difference (RR 0. 95, 95% CI 0. 90 to 1. 00) (low certainty); observational studies showed that MRI may have no difference in the odds of re-operation after BCS (OR 0. 96; 95% CI 0. 36 to 2. 61) (low certainty); and uncertain evidence from RCTs suggests little to no difference with respect to total mastectomy rate (RR 0. 91; 95% CI 0. 65 to 1. 27) (very low certainty). We also found that MRI may change the initial treatment plans in 17% (95% CI 12 to 24%) of cases, but with little to no effect on locoregional recurrence (aHR = 1. 18; 95% CI 0. 79 to 1. 76) (very low certainty). Conclusion: We found evidence of low to very low certainty which may suggest there is no improvement of surgical outcomes with pre-operative MRI assessment of women with DCIS lesions. There is a need for large rigorously conducted RCTs to evaluate the role of preoperative MRI in this population. Key Points: • Evidence of low to very low certainty may suggest there is no improvement in surgical outcomes with pre-operative MRI. • There is a need for large rigorously conducted RCTs evaluating the role of preoperative MRI to improve treatment planning for DCIS.
Ajuts:	European Commission 443094
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	Breast cancer ; Ductal carcinoma in situ ; Magnetic resonance imaging
Publicat a:	European Radiology, Vol. 31 Núm. 8 (august 2021) , p. 5880-5893, ISSN 1432-1084

DOI: 10.1007/s00330-021-07873-2
PMID: 34052881

14 p, 2.0 MB

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