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

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.