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Li Z, Gao Y, Gong H, Feng W, Ma Q, Li J, Lu X, Wang X, Lei J. Different Imaging Modalities for the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis of Diagnostic Test Accuracy. J Magn Reson Imaging 2022; 57:1392-1403. [PMID: 36054564 DOI: 10.1002/jmri.28399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Accurate diagnosis of axillary lymph node metastasis (ALNM) of breast cancer patients is important to guide local and systemic treatment. PURPOSE To evaluate the diagnostic performance of different imaging modalities for ALNM in patients with breast cancer. STUDY TYPE Systematic review and network meta-analysis (NMA). SUBJECTS Sixty-one original articles with 8011 participants. FIELD STRENGTH 1.5 T and 3.0 T. ASSESSMENT We used the QUADAS-2 and QUADAS-C tools to assess the risk of bias in eligible studies. The identified articles assessed ultrasonography (US), MRI, mammography, ultrasound elastography (UE), PET, CT, PET/CT, scintimammography, and PET/MRI. STATISTICAL ANALYSIS We used random-effects conventional meta-analyses and Bayesian network meta-analyses for data analyses. We used sensitivity and specificity, relative sensitivity and specificity, superiority index, and summary receiver operating characteristic curve (SROC) analysis to compare the diagnostic value of different imaging modalities. RESULTS Sixty-one studies evaluated nine imaging modalities. At patient level, sensitivities of the nine imaging modalities ranged from 0.27 to 0.84 and specificities ranged from 0.84 to 0.95. Patient-based NMA showed that UE had the highest superiority index (5.95) with the highest relative sensitivity of 1.13 (95% confidence interval [CI]: 0.93-1.29) among all imaging methods when compared to US. At lymph node level, MRI had the highest superiority index (6.91) with highest relative sensitivity of 1.13 (95% CI: 1.01-1.23) and highest relative specificity of 1.11 (95% CI: 0.95-1.23) among all imaging methods when compared to US. SROCs also showed that UE and MRI had the largest area under the curve (AUC) at patient level and lymph node level of 0.92 and 0.94, respectively. DATA CONCLUSION UE and MRI may be superior to other imaging modalities in the diagnosis of ALNM in breast cancer patients at the patient level and the lymph node level, respectively. Further studies are needed to provide high-quality evidence to validate our findings. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Zhifan Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Hengxin Gong
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Wen Feng
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Qinqin Ma
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Jinkui Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xingru Lu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China.,Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaohui Wang
- Department of Obstetrics and Gynecology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Junqiang Lei
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
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Le Boulc’h M, Gilhodes J, Steinmeyer Z, Molière S, Mathelin C. Pretherapeutic Imaging for Axillary Staging in Breast Cancer: A Systematic Review and Meta-Analysis of Ultrasound, MRI and FDG PET. J Clin Med 2021; 10:jcm10071543. [PMID: 33917590 PMCID: PMC8038849 DOI: 10.3390/jcm10071543] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/07/2021] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This systematic review aimed at comparing performances of ultrasonography (US), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (PET) for axillary staging, with a focus on micro- or micrometastases. METHODS A search for relevant studies published between January 2002 and March 2018 was conducted in MEDLINE database. Study quality was assessed using the QUality Assessment of Diagnostic Accuracy Studies checklist. Sensitivity and specificity were meta-analyzed using a bivariate random effects approach; Results: Across 62 studies (n = 10,374 patients), sensitivity and specificity to detect metastatic ALN were, respectively, 51% (95% CI: 43-59%) and 100% (95% CI: 99-100%) for US, 83% (95% CI: 72-91%) and 85% (95% CI: 72-92%) for MRI, and 49% (95% CI: 39-59%) and 94% (95% CI: 91-96%) for PET. Interestingly, US detects a significant proportion of macrometastases (false negative rate was 0.28 (0.22, 0.34) for more than 2 metastatic ALN and 0.96 (0.86, 0.99) for micrometastases). In contrast, PET tends to detect a significant proportion of micrometastases (true positive rate = 0.41 (0.29, 0.54)). Data are not available for MRI. CONCLUSIONS In comparison with MRI and PET Fluorodeoxyglucose (FDG), US is an effective technique for axillary triage, especially to detect high metastatic burden without upstaging majority of micrometastases.
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Affiliation(s)
- Morwenn Le Boulc’h
- Department of Oncologic Radiology, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse-Oncopole, 31100 Toulouse, France;
| | - Julia Gilhodes
- Clinical Trials, Institut Universitaire du Cancer de Toulouse-Oncopole, 31100 Toulouse, France;
| | - Zara Steinmeyer
- Internal Medicine and Oncogeriatry Unit, Geriatric Department, University Hospital, Place du Docteur Baylac, CEDEX 9, 31059 Toulouse, France;
| | - Sébastien Molière
- Department of Women’s Imaging, University Hospitals of Strasbourg, 67200 Strasbourg, France;
| | - Carole Mathelin
- Surgery at ICANS Cancer Institute (Institute of Cancerology Strasbourg Europe), CEDEX, 67033 Strasbourg, France
- Correspondence: ; Tel.: +33-3-6876-7332
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Ismail HM, Pretty CG, Signal MK, Haggers M, Chase JG. Attributes, Performance, and Gaps in Current & Emerging Breast Cancer Screening Technologies. Curr Med Imaging 2019; 15:122-131. [DOI: 10.2174/1573405613666170825115032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 08/15/2017] [Accepted: 08/22/2017] [Indexed: 01/29/2023]
Abstract
Background:Early detection of breast cancer, combined with effective treatment, can reduce mortality. Millions of women are diagnosed with breast cancer and many die every year globally. Numerous early detection screening tests have been employed. A wide range of current breast cancer screening methods are reviewed based on a series of searchers focused on clinical testing and performance. </P><P> Discussion: The key factors evaluated centre around the trade-offs between accuracy (sensitivity and specificity), operator dependence of results, invasiveness, comfort, time required, and cost. All of these factors affect the quality of the screen, access/eligibility, and/or compliance to screening programs by eligible women. This survey article provides an overview of the working principles, benefits, limitations, performance, and cost of current breast cancer detection techniques. It is based on an extensive literature review focusing on published works reporting the main performance, cost, and comfort/compliance metrics considered.Conclusion:Due to limitations and drawbacks of existing breast cancer screening methods there is a need for better screening methods. Emerging, non-invasive methods offer promise to mitigate the issues particularly around comfort/pain and radiation dose, which would improve compliance and enable all ages to be screened regularly. However, these methods must still undergo significant validation testing to prove they can provide realistic screening alternatives to the current accepted standards.
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Affiliation(s)
- Hina M. Ismail
- University of Canterbury, Christchurch, Canterbury, New Zealand
| | | | | | - Marcus Haggers
- Tiro Medical Limited, Christchurch, Canterbury, New Zealand
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Song SE, Seo BK, Cho KR, Woo OH, Son GS, Kim C, Cho SB, Kwon SS. Computer-aided detection (CAD) system for breast MRI in assessment of local tumor extent, nodal status, and multifocality of invasive breast cancers: preliminary study. Cancer Imaging 2015; 15:1. [PMID: 25888983 PMCID: PMC4344797 DOI: 10.1186/s40644-015-0036-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 01/07/2015] [Indexed: 11/23/2022] Open
Abstract
Background We aimed to investigate the efficacy of computer-aided detection (CAD) for MRI in the assessment of tumor extent, lymph node status, and multifocality in invasive breast cancers in comparison with other breast imaging modalities. Methods Two radiologists measured the maximum tumor size, as well as, analyzed lymph node status and multifocality in 86 patients with invasive breast cancers using mammography, ultrasound, CT, MRI with and without CAD, and 18-fludeoxyglucose positron emission tomography (FDG-PET). The assessed data were compared with pathology. Results For tumor extent, there were no significant differences between pathological size and measured size using mammography, ultrasound, CT, or MRI with and without CAD (P > 0.05). For evaluation of lymph node status, ultrasound had the best kappa coefficients (0.522) for agreement between imaging and pathology, and diagnostic performance with 92.1% specificity and 90.0% positive predictive value. For multifocality, MRI with CAD had the highest area under the receiver operating characteristic curve (AUC = 0.888). Conclusions CAD for MRI is feasible to assess tumor extent and multifocality in invasive breast cancer patients. However, CAD is not effective in evaluation of nodal status.
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Affiliation(s)
- Sung Eun Song
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan city, Gyeonggi-do, 425-707, Korea.
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan city, Gyeonggi-do, 425-707, Korea.
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 136-705, Korea.
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, Korea.
| | - Gil Soo Son
- Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan city, Gyeonggi-do, 425-707, Korea.
| | - Chulhan Kim
- Department of Nuclear Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan city, Gyeonggi-do, 425-707, Korea.
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul, 136-705, Korea.
| | - Soon-Sun Kwon
- Department of Biostatistics, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Seongnam-si, Gyeonggi-do, 463-707, Korea.
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Axillary ultrasound in patients with clinically node-negative breast cancer: which features are predictive of disease? J Surg Res 2013; 184:234-40. [DOI: 10.1016/j.jss.2013.03.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/17/2013] [Accepted: 03/20/2013] [Indexed: 02/05/2023]
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Single-photon-emission computed tomography (SPECT) with technetium-99m sestamibi in the diagnosis of small breast cancer and axillary lymph node involvement. World J Surg 2012; 35:2668-72. [PMID: 22002494 DOI: 10.1007/s00268-011-1267-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In a prospective study we evaluated the accuracy, sensitivity, and specificity of single-photon-emission computed tomography (SPECT) technetium-99m (99Tcm) sestamibi scintimammography to differentiate between benign and malignant small solid lesions of the breast, and to diagnose axillary node involvement in patients with small breast tumors. METHODS We prospectively evaluated 172 women with a solid lesion of the breast less than 3 cm in diameter and no evidence of axillary lymph node involvement on physical examination, ultrasound, and mammography. Thereafter, all patients underwent excision of the lesion, and, if pathology was positive for cancer, quadrantectomy and axillary lymph node dissection independently by the results of scintimammography. RESULTS There were 92 patients with a benign lesion and 80 patients with cancer. SPECT scintimammography correctly identified all 80 patients with cancer; there were six false-positive cases and no false-negative cases for a test efficacy of 96.5%, sensitivity of 100%, and specificity of 93.5%. Forty-five of the 80 patients with cancer had axillary lymph node involvement and scintimammography correctly identified 39 of the 45 patients. There was one false-positive case and six false-negative cases for a test efficacy of 90%, sensitivity of 86.4%, and specificity of 97.5%. CONCLUSION SPECT scintimammography should be considered selectively in the preoperative evaluation of patients with small solid lesions of the breast. It allows correct identification of patients with cancer and identification of a significant number of patients with axillary lymph node involvement.
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Wasser K, Schnitzer A, Brade J, Schoenberg SO. [Non-invasive imaging modalities for preoperative axillary lymph node staging in patients with breast cancer]. Radiologe 2011; 50:1022-9. [PMID: 20953577 DOI: 10.1007/s00117-010-2072-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In the last decade sentinel lymph node biopsy has become a well-established method for axillary lymph node staging in patients with breast cancer. Using preoperative imaging modalities it can be tested whether patients are suitable for sentinel node biopsy or if they should directly undergo an axillary dissection. The imaging modalities used must be mainly characterized by a high positive predictive value (PPV). For this question B-mode ultrasound is the best evaluated method and provides clear morphological signs for a high PPV (>90%) but the sensitivity barely exceeds 50%. It has not yet been proven whether other modalities such as duplex sonography, magnetic resonance imaging, computed tomography (CT) or scintigraphy might achieve a higher sensitivity while still maintaining a high PPV. There is only some evidence that positron emission tomography (PET) might achieve a higher sensitivity. This should be confirmed by further studies because PET or PET/CT will play an increasing role for an initial whole body staging in patients with breast cancer in the near future.
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Affiliation(s)
- K Wasser
- Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Deutschland.
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Neal CH, Daly CP, Nees AV, Helvie MA. Can Preoperative Axillary US Help Exclude N2 and N3 Metastatic Breast Cancer? Radiology 2010; 257:335-41. [DOI: 10.1148/radiol.10100296] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hur SM, Kim SH, Lee SK, Kim WW, Choi JH, Kim S, Lee SJ, Choi JY, Choe JH, Kim JH, Kim JS, Nam SJ, Yang JH, Lee JE. The Preoperative Role of Breast-specific Gamma Imaging for the Breast Cancer Patients: In Comparison with Conventional Imaging Modality. J Breast Cancer 2010. [DOI: 10.4048/jbc.2010.13.2.198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sung Mo Hur
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Kyung Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Wook Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hyuck Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su-Jin Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Ho Choe
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Han Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jee Soo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok-Jin Nam
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Hyun Yang
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Franc BL, Hawkins RA. Positron Emission Tomography, Positron Emission Tomography–Computed Tomography, and Molecular Imaging of the Breast Cancer Patient. Semin Roentgenol 2007; 42:265-79. [DOI: 10.1053/j.ro.2007.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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