Potential role of breast MRI to identify patients with high-risk lesions who might avoid surgery: a systematic review and meta-analysis

Question Can contrast-enhanced breast MRI help to rule out malignancy in patients with high-risk lesions at imaging-guided biopsy, thereby supporting more tailored decisions and potentially reducing unnecessary surgical excisions? Findings Contrast-enhanced breast MRI may reduce unnecessary surgical or vacuum excisions in high-risk (B3) lesions. Missed cancers were limited to small low-grade DCIS. Clinical relevance Contrast-enhanced breast MRI may support the identification of patients with high-risk lesions who could potentially avoid surgery. This non-invasive approach has the potential to reduce overtreatment, healthcare costs, and patient anxiety, while maintaining a high negative predictive value.