Accuracy of MR imaging in the work-up of suspicious breast lesions: a diagnostic meta-analysis.

RATIONALE AND OBJECTIVES The authors performed a systematic, critical review of the literature on magnetic resonance (MR) imaging for primary breast cancer detection in patients with suspicious breast lesions, analyzed MR test performance in the articles meeting study criteria, and used this information to examine the cost-effectiveness of preoperative MR imaging. MATERIALS AND METHODS A structured, predefined MEDLINE search was conducted to identify potentially relevant, peer-reviewed, English-language references from January 1996 through August 1997 on the diagnostic accuracy of breast MR imaging. This information was supplemented by manually searching bibliographies of the retrieved articles for additional potentially relevant references. All studies were independently abstracted by two reviewers using a prospectively designed worksheet. Abstraction results were analyzed with the summary receiver operating characteristic (ROC) method. RESULTS Of 41 identified studies, 16 met the inclusion criteria. These studies reported sensitivities ranging from 63% to 100% and specificities ranging from 21% to 100%. Maximum joint sensitivity and specificity of the summary ROC curve was 89% (95% confidence interval [CI]: 82%, 93%). At a sensitivity of 95%, specificity was 67%. When test performance values were applied to a previous cost-effectiveness analysis, the cost-effectiveness of preoperative MR imaging relative to that of excisional biopsy was confirmed, but its cost-effectiveness relative to that of needle core biopsy varied widely. CONCLUSION For MR imaging to be a cost-effective alternative to excisional biopsy for diagnosis of suspicious breast lesions, its diagnostic test performance must be equal to or better than the best results in recently published studies.