Accuracy of MRI in prediction of pathologic complete remission in breast cancer after preoperative therapy: a meta-analysis.

Abstract

Prediction of pathologic complete remission in breast cancer after preoperative therapy presents difficulties. We performed a meta-analysis to determine the ability of MRI to predict pathologic complete remission in patients with breast cancer after preoperative therapy. Medical subject heading terms ("MRI" and "Breast Neoplasm") and key words ("neoadjuvant" or "primary systemic" or "preoperative" or "presurgery") were used for a literature search in the MEDLINE database. A meta-analysis of pooled data from eligible studies was performed to estimate the accuracy of MRI in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. Twenty-five studies were included in this meta-analysis. Pooled weighted estimates of sensitivity and specificity were 0.63 (range, 0.56-0.70) and 0.91 (range, 90.89-0.92), respectively. Heterogeneity between studies was highly influenced by the pathologic complete remission rate, with a regression coefficient of -6.160 (p = 0.020). Subgroup analysis showed that the specificity of MRI in studies with a pathologic complete remission rate of > or = 20% was lower than that in studies with a pathologic complete remission rate of < 20% (p = 0.0003). This meta-analysis indicates that MRI has high specificity and relatively lower sensitivity in predicting pathologic complete remission after preoperative therapy in patients with breast cancer. The pathologic complete remission rate may influence the performance of MRI accuracy in this setting, which deserves further investigation.