Performance Benchmark Metrics and Clinicopathologic Outcomes of MRI-Guided Breast Biopsies: A Systematic Review and Meta-Analysis.

Berat Bersu Özcan, Justin Yan, Yin Xi, Serine Baydoun, Marion E Scoggins, Başak E Doğan
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引用次数: 0

Abstract

Objective To determine key performance metrics of magnetic resonance imaging (MRI)-guided breast biopsies (MRGB) to help identify reference benchmarks. Materials and Methods We identified studies reporting MRGB results up to 04.01.2021 in the Embase database, Ovid Medline (R) Process, Other Non-Indexed Citations, Ovid Medline (R) and completed a PRISMA checklist and sources of bias (QUADAS-2). The inclusion criteria were English language, available histopathological outcomes, or at least one imaging follow-up after biopsy. A random intercept logistic regression model was used to pool rates. Between-study heterogeneity was quantified by the I2 statistic. Results A total of 11,215 lesions in 50 articles were analyzed. The technical success rate was 99.10% [95% confidence interval (CI): 97.89-99.62%]. The MRI indications were staging in 1,496 (28.05%, 95% CI: 26.85-29.28%), screening in 1,427 (26.76%, 95% CI: 25.57-27.97%), surveillance in 1,027 (19.26%, 95% CI: 18.21-20.34%), diagnostic in 1,038 (19.46%, 95% CI: 18.41-20.55%), unknown primary in 74 (1.39%, 95% CI: 1.09-1.74%), and other in 271 (5.08%, 95% CI: 4.51-5.71%). Histopathology was benign in 65.06% (95% CI: 59.15-70.54%), malignant in 29.64% (95% CI: 23.58-36.52%) and high risk in 16.69% (95% CI: 9.96-26.64%). Detection of malignancy was significantly lower in those patients who underwent MRI for screening purposes (odds ratio 0.47, 95% CI: 0.25-0.87; p = 0.02), while mass lesions were more likely to yield malignancy compared to non-mass and foci [27.39% vs 11.36% (non-mass),18.03% (foci); p<0.001]. Surgical upgrade to invasive cancer occurred in 12.24% of ductal carcinoma in situ (95% CI: 7.76-18.77%) and malignancy in 15.14% of high-risk lesions (95% CI: 10.69-21.17%). MRI follow-up was performed in 1,651 (20.92%) patients after benign results [median=25 months (range: 0.4-117)]. Radiology-pathology discordance (2.48%, 95% CI: 1.62-3.77%), false negative after a benign-concordant biopsy (0.75%, 95% CI: 0.34-1.62%) and biopsy complications (2.36%, 95% CI: 2.03-2.72%) were rare. Conclusion MRGB is a highly accurate minimally-invasive diagnostic technique with low false-negative and complication rates. MRI indication and lesion type should be considered when evaluating the performance of institutional MRGB programs.
mri引导乳腺活检的性能基准指标和临床病理结果:系统回顾和荟萃分析。
目的:确定磁共振成像(MRI)引导下乳腺活检(MRGB)的关键性能指标,以帮助确定参考基准。材料和方法:我们在Embase数据库、Ovid Medline (R) Process、其他非索引引文、Ovid Medline (R)中确定了截至2021年1月4日报告MRGB结果的研究,并完成了PRISMA清单和偏倚来源(QUADAS-2)。纳入标准为英语,可用的组织病理学结果,或活检后至少一次影像学随访。采用随机截距logistic回归模型对费率进行汇总。研究间异质性采用I2统计量进行量化。结果:共分析了50篇文献中的11215个病变。技术成功率为99.10%[95%置信区间(CI): 97.89 ~ 99.62%]。MRI指征为分期1496例(28.05%,95% CI: 26.85-29.28%),筛查1427例(26.76%,95% CI: 25.57-27.97%),监测1027例(19.26%,95% CI: 18.21-20.34%),诊断1038例(19.46%,95% CI: 18.41-20.55%),原发不明74例(1.39%,95% CI: 1.09-1.74%),其他271例(5.08%,95% CI: 4.51-5.71%)。组织病理学良性占65.06% (95% CI: 59.15 ~ 70.54%),恶性占29.64% (95% CI: 23.58 ~ 36.52%),高危占16.69% (95% CI: 9.96 ~ 26.64%)。在接受MRI筛查的患者中,恶性肿瘤的检出率明显较低(优势比0.47,95% CI: 0.25-0.87;P = 0.02),而肿块病变较非肿块和灶性病变更容易发生恶性肿瘤[27.39%对11.36%(非肿块),18.03%(灶);结论:MRGB是一种准确率高、假阴性率低、并发症发生率低的微创诊断技术。在评估机构MRGB项目的表现时,应考虑MRI指征和病变类型。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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