背景:乳腺癌患者腋窝淋巴结转移(ALNM)的准确诊断对指导局部和全身治疗具有重要意义。
目的:评价不同影像学检查方法对乳腺癌患者ALNM的诊断效果。
方法:系统评价和网络荟萃分析(NMA)。
方法:61篇原创文章,有8011名参与者。
未授权:1.5T和3.0T
结果:我们使用QUADAS-2和QUADAS-C工具评估合格研究中的偏倚风险。已确定的文章评估了超声检查(美国),MRI,乳房X线照相术,超声弹性成像(UE),PET,CT,PET/CT,乳房造影,PET/MRI。
方法:我们使用随机效应常规meta分析和贝叶斯网络meta分析进行数据分析。我们使用了敏感性和特异性,相对灵敏度和特异性,优势指数,并总结受试者工作特征曲线(SROC)分析,比较不同成像方式的诊断价值。
结果:61项研究评估了9种成像方式。在患者层面,9种成像方式的敏感性为0.27~0.84,特异性为0.84~0.95.基于患者的NMA显示,与US相比,UE在所有成像方法中具有最高的优势指数(5.95),最高的相对灵敏度为1.13(95%置信区间[CI]:0.93-1.29)。在淋巴结水平,与US相比,MRI具有最高的优势指数(6.91),最高的相对灵敏度为1.13(95%CI:1.01-1.23),最高的相对特异性为1.11(95%CI:0.95-1.23)。SROC还显示UE和MRI在患者水平和淋巴结水平的曲线下面积(AUC)最大,分别为0.92和0.94。
结论:UE和MRI在乳腺癌患者的患者水平和淋巴结水平诊断ALNM方面可能优于其他影像学方式,分别。需要进一步的研究来提供高质量的证据来验证我们的发现。
方法:3技术效果:阶段2。
Accurate diagnosis of
axillary lymph node metastasis (ALNM) of breast cancer patients is important to guide local and systemic treatment.
To evaluate the diagnostic performance of different imaging modalities for ALNM in patients with breast cancer.
Systematic
review and network meta-analysis (NMA).
Sixty-one original articles with 8011 participants.
1.5 T and 3.0 T.
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.
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.
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.
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.
3 TECHNICAL EFFICACY: Stage 2.