目的:本系统评价磁共振成像(MRI)对乳腺癌患者新辅助化疗(NAC)后腋窝淋巴结状态(ALNS)的诊断价值。
方法:我们搜索了PubMed,Embase,科克伦图书馆,和WebofScience确定相关研究,并使用QUADAS-2工具评估合格研究的方法学质量。我们使用STATA版本12.0来执行数据池,异质性测试,亚组分析,和敏感性分析。
结果:对于21项注册研究,包括2875名患者,汇集的敏感性,特异性,正似然比,负似然比,和诊断比值比分别为0.63(95%CI:0.53-0.72),0.75(95%CI:0.68-0.81),2.52(95%CI:1.98-3.19),0.50(95%CI:0.39-0.63),和5.08(95%CI:3.38-7.63)。AUC为0.76(95%CI:0.72-0.79)。灵敏度(I2=94.41%)和特异度(I2=88.97%)的I2值均>50%。对于最初的ALN阳性患者,合并的敏感性和特异性分别为0.64(95%CI:0.53-0.75)和0.74(95%CI:0.64-0.82),分别。通过关注NAC后进行的MRI研究进行敏感性分析,使用DCE-MRI的研究,或偏倚风险较低的研究显示与主要分析相似的结果.
结论:MRI在评估乳腺癌患者NAC后ALNS方面可能具有次优诊断价值。由于NAC方案的不一致,腋窝手术的变异性,磁共振成像和手术之间没有时间间隔,我们需要进一步的研究来证实我们的发现.
结论:我们的研究为评估乳腺癌患者新辅助化疗后的腋窝淋巴结状态提供了诊断价值。
结论:•MRI在评估普通乳腺癌患者NAC术后腋窝淋巴结状态方面可能具有次优诊断价值。•初始腋窝淋巴结状态对MRI的诊断效能影响不大。研究之间的实质性异质性突出了需要进一步的研究,以提供更多高质量的证据在这一领域。
OBJECTIVE: This systematic
review examined the diagnostic performance of magnetic resonance imaging (MRI) for assessing axillary lymph node status (ALNS) after neoadjuvant chemotherapy (NAC) in breast cancer patients.
METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science to identify relevant studies and used the QUADAS-2 tool to assess methodological quality of eligible studies. We used STATA version 12.0 to perform data pooling, heterogeneity testing, subgroup analysis, and sensitivity analysis.
RESULTS: For the 21 enrolled studies, including 2875 patients, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were respectively 0.63 (95% CI: 0.53-0.72), 0.75 (95% CI: 0.68-0.81), 2.52 (95% CI: 1.98-3.19), 0.50 (95% CI: 0.39-0.63), and 5.08 (95% CI: 3.38-7.63). The AUC was 0.76 (95% CI: 0.72-0.79). I2 values of sensitivity (I2 = 94.41%) and specificity (I2 = 88.97%) were both > 50%. For the initial positive ALN patients, the pooled sensitivity and specificity were 0.64 (95% CI: 0.53-0.75) and 0.74 (95% CI: 0.64-0.82), respectively. Sensitivity analyses by focusing on studies with MRI performed post-NAC, studies using DCE-MRI, or studies with low risk of bias showed similar results to the primary analyses.
CONCLUSIONS: MRI may have suboptimal diagnostic value in assessing ALNS after NAC for breast cancer patients. Due to the inconsistency of NAC regimens, the variability of axillary surgery, and the lack of time interval between MRI and surgery, further studies are needed to confirm our findings.
CONCLUSIONS: Our study provided the diagnostic value of MRI in assessing axillary lymph node status after neoadjuvant chemotherapy for breast cancer patients.
CONCLUSIONS: • MRI may have suboptimal diagnostic value in assessing axillary lymph node status after NAC for general breast cancer patients. • The initial axillary lymph node status has little impact on the diagnostic efficacy of MRI. • The substantial heterogeneity among studies highlights the need for further studies to provide more high-quality evidence in this field.