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Di Leo G, Trimboli RM, Benedek A, Jereczek-Fossa BA, Fossati P, Leonardi MC, Carbonaro LA, Orecchia R, Sardanelli F. MR Imaging for Selection of Patients for Partial Breast Irradiation: A Systematic Review and Meta-Analysis. Radiology 2015; 277:716-26. [PMID: 26043263 DOI: 10.1148/radiol.2015142508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To systematically review articles that estimated the ineligibility for partial breast irradiation (PBI) after magnetic resonance (MR) imaging. MATERIALS AND METHODS No ethics committee approval was needed. A systematic search was performed by using MEDLINE and EMBASE. The rate of patients eligible at standard assessment (ie, clinical examination, mammography, and/or ultrasonography) but ineligible after MR imaging was a study outcome. Odds ratios (ORs) were calculated to identify predictors. Quality was appraised by using the Strengthening Reporting of Observational Studies in Epidemiology checklist. RESULTS Of 93 retrieved articles, six were included (total, 3136 patients). For PBI eligibility, all studies applied National Surgical Adjuvant Breast and Bowel Project B-39 criteria. Ineligibility at standard assessment varied from 21% to 80%; MR imaging prompted ineligibility for PBI in 6%-25% of patients who were initially deemed eligible or in 2%-20% if calculated on the overall number of patients initially screened. Meta-regression showed a negative correlation between ineligibility at standard assessment and ineligibility after MR imaging (P < .001). The pooled percentage of patients eligible at standard assessment but ineligible after MR imaging was 11% (95% confidence interval [CI]: 6%, 19%). Predictors for ineligibility after MR imaging were cancers stage pT2 or greater versus less than stage pT2 (OR, 8.8 [95% CI: 4.7, 16.7]; P < .001), invasive lobular histopathologic results versus invasive ductal pathologic results (OR, 3.0 [95% CI: 1.6, 6.6]; P = .007), pre- versus postmenopausal status (OR, 1.9 [95% CI: 1.3, 2.6]; P < .001), invasive cancer versus ductal carcinoma in situ (OR, 1.6 [95% CI: 1.0, 2.4]; P = .031). Study quality ranged from 17 to 20 (maximum quality, 22). The risk of publication bias was moderate. CONCLUSION One of nine women (11%), who on the sole basis of standard assessment were candidates to undergo PBI, was found to be ineligible after undergoing MR imaging. Breast MR imaging should be used to select patients for PBI.
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Affiliation(s)
- Giovanni Di Leo
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Rubina Manuela Trimboli
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Adrienn Benedek
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Barbara Alicja Jereczek-Fossa
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Piero Fossati
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Maria Cristina Leonardi
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Luca Alessandro Carbonaro
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Roberto Orecchia
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Francesco Sardanelli
- From the Radiology Unit, IRCCS Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy (G.D.L., R.M.T., A.B., L.A.C., F.S.); Department of Radiation Oncology, European Institute of Oncology, Università degli Studi di Milano, Milan, Italy (B.A.J.F., P.F., M.C.L., R.O.); CNAO, Pavia, Italy (P.F., R.O.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
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