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Radiology Surveillance for Breast Cancer Survivors: A Systematic Review and Meta-Analysis.

Ajeng Viska Icanervilia1,2, Lina Choridah1, Afdina Melya G Febiyanti3

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Mammographic surveillance significantly reduces breast cancer mortality in survivors, despite lower accuracy than in screening. Adjunct imaging like MRI may improve early detection and outcomes.

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Area of Science:

  • Oncology
  • Radiology
  • Medical Imaging

Background:

  • Breast cancer is a leading cause of mortality globally, with survivors requiring effective post-treatment surveillance.
  • Radiologic surveillance is crucial for early detection of recurrence and secondary malignancies.
  • Existing imaging modalities present disparities in accuracy and effectiveness for breast cancer surveillance.

Purpose of the Study:

  • To systematically review and meta-analyze the effectiveness of various radiologic surveillance techniques in breast cancer survivors.
  • To evaluate the diagnostic accuracy of different imaging modalities for detecting recurrence.
  • To assess the impact of surveillance on mortality reduction in breast cancer survivors.

Main Methods:

  • Systematic review and meta-analysis of studies on radiologic surveillance (mammography, ultrasonography, MRI, digital breast tomosynthesis).
  • Comprehensive literature search across Medline, Cochrane Central Register of Controlled Trials, and Scopus.
  • Data synthesis using a random-effects model to determine pooled sensitivity, specificity, accuracy, and mortality reduction.
  • Risk of bias assessment using Newcastle-Ottawa Scale and QUADAS-2.

Main Results:

  • Eighteen studies were included, with eight contributing to the meta-analysis (three for diagnostic accuracy, five for mortality).
  • Mammographic surveillance showed pooled sensitivity of 81%, specificity of 71%, and accuracy of 76%.
  • Mammographic surveillance was associated with a 50% reduction in mortality risk (OR 0.50).
  • Magnetic resonance imaging (MRI) demonstrated superior sensitivity (91%) and specificity (82%) compared to ultrasonography and mammography.

Conclusions:

  • Mammographic surveillance, while less accurate in survivors than in screening, significantly reduces breast cancer mortality.
  • Adjunct imaging modalities like MRI can potentially enhance early detection of recurrence.
  • Standardized surveillance protocols and further research are needed to optimize imaging strategies for diverse survivor populations.