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

Michael L. Marinovich, Petra Macaskill, Les Irwig, Francesco Sardanelli, Eleftherios Mamounas, Gunter von Minckwitz, Valentina Guarneri, Savannah C. Partridge, Frances C. Wright, Jae Hyuck Choi, Madhumita Bhattacharyya, Laura Martincich, Eren Yeh, Viviana Londero, Nehmat Houssami

Research output: Contribution to journalArticle

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Abstract

Background: Magnetic 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. Methods: A 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. Results: Eight 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 %). Conclusions: There 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.

Original languageEnglish
Article number662
JournalBMC Cancer
Volume15
Issue number1
DOIs
Publication statusPublished - Oct 8 2015

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Meta-Analysis
Magnetic Resonance Imaging
Breast Neoplasms
Drug Therapy
Mammography
Residual Neoplasm
Pathology
Neoplasms
Mammary Ultrasonography
Databases
Biomedical Technology Assessment
Reoperation
MEDLINE

Keywords

  • Breast cancer
  • Magnetic resonance imaging
  • Monitoring
  • Neoadjuvant chemotherapy
  • Tumor response

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Genetics

Cite this

Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests : Individual patient data meta-analysis. / Marinovich, Michael L.; Macaskill, Petra; Irwig, Les; Sardanelli, Francesco; Mamounas, Eleftherios; von Minckwitz, Gunter; Guarneri, Valentina; Partridge, Savannah C.; Wright, Frances C.; Choi, Jae Hyuck; Bhattacharyya, Madhumita; Martincich, Laura; Yeh, Eren; Londero, Viviana; Houssami, Nehmat.

In: BMC Cancer, Vol. 15, No. 1, 662, 08.10.2015.

Research output: Contribution to journalArticle

Marinovich, ML, Macaskill, P, Irwig, L, Sardanelli, F, Mamounas, E, von Minckwitz, G, Guarneri, V, Partridge, SC, Wright, FC, Choi, JH, Bhattacharyya, M, Martincich, L, Yeh, E, Londero, V & Houssami, N 2015, 'Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests: Individual patient data meta-analysis', BMC Cancer, vol. 15, no. 1, 662. https://doi.org/10.1186/s12885-015-1664-4
Marinovich, Michael L. ; Macaskill, Petra ; Irwig, Les ; Sardanelli, Francesco ; Mamounas, Eleftherios ; von Minckwitz, Gunter ; Guarneri, Valentina ; Partridge, Savannah C. ; Wright, Frances C. ; Choi, Jae Hyuck ; Bhattacharyya, Madhumita ; Martincich, Laura ; Yeh, Eren ; Londero, Viviana ; Houssami, Nehmat. / Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests : Individual patient data meta-analysis. In: BMC Cancer. 2015 ; Vol. 15, No. 1.
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T1 - Agreement between MRI and pathologic breast tumor size after neoadjuvant chemotherapy, and comparison with alternative tests

T2 - Individual patient data meta-analysis

AU - Marinovich, Michael L.

AU - Macaskill, Petra

AU - Irwig, Les

AU - Sardanelli, Francesco

AU - Mamounas, Eleftherios

AU - von Minckwitz, Gunter

AU - Guarneri, Valentina

AU - Partridge, Savannah C.

AU - Wright, Frances C.

AU - Choi, Jae Hyuck

AU - Bhattacharyya, Madhumita

AU - Martincich, Laura

AU - Yeh, Eren

AU - Londero, Viviana

AU - Houssami, Nehmat

PY - 2015/10/8

Y1 - 2015/10/8

N2 - Background: Magnetic 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. Methods: A 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. Results: Eight 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 %). Conclusions: There 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.

AB - Background: Magnetic 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. Methods: A 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. Results: Eight 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 %). Conclusions: There 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.

KW - Breast cancer

KW - Magnetic resonance imaging

KW - Monitoring

KW - Neoadjuvant chemotherapy

KW - Tumor response

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