Diagnostic Value of MRI combined with Ultrasound for Lymph Node in Breast Cancer: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGRong ¹ , LIUHai-feng ^1,2 , HUSha-sha ^1,2 , PEICai-xia ¹ , MAWen-ting ^1,2 , LIJin-kui ¹ ,  GUOQi-hong ¹

1. Department of Radiology, First Hospital of Lanzhou University, Lanzhou 73000, China;
2. The First Medical College, Lanzhou University, Lanzhou 73000, China;

Corresponding author：

GUOQi-hong, Email: leijq2011@126.com

Keywords：

MRI; Ultrasound; Breast cancer; Lymph node; Meta-analysis

DOI：

10.7507/1672-2531.20160208

Video：

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Objective To systematically evaluate the value of magnetic resonance imaging (MRI) combined with ultrasound in the diagnosis of node metastases in breast cancer patients. Methods The articles concerning the diagnosis of node metastases by using MRI combined with ultrasound until September 2016 were searched in the databases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, WanFang Data and CNKI. Two reviewers independently screened literature, extracted data according to pre-set included and excluded criteria, and assessed the risk of bias of included studies by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. Then, meta-analysis was performed by using Stata 12.0 software. The pooled weighted sensitivity (Sen), specificity (Spe), Positive likehoodn (+LR), Negative likehood (-LR) and diagnostic odds ratio (DOR) were calculated, the summary receiver operating characteristic (SROC) curve was drawn and the area under the curve was calculated. Results A total of eight studies were included, involving 2 288 patients. The pooled Sen, Spe, +LR,-LR, DOR and area under SROC curve of MRI combined with ultrasound in the diagnosis of breast cancer patients with node metastases were 0.74 (95%CI 0.54 to 0.87), 0.95 (95%CI 0.88 to 0.98), 13.95 (95%CI 6.04 to 32.22), 0.28 (95%CI 0.15 to 0.52), 50.38 (95%CI 17.56 to 144.60), and 0.94 (95%CI 0.91 to 0.96), respectively. Conclusion MRI combined with ultrasound has more diagnostic efficiency for assessing lymph node in breast cancer, therefore, it can be used as an effective method with the diagnosis of node metastases in breast cancer patients.

Citation： ZHANGRong, LIUHai-feng, HUSha-sha, PEICai-xia, MAWen-ting, LIJin-kui, GUOQi-hong. Diagnostic Value of MRI combined with Ultrasound for Lymph Node in Breast Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(12): 1374-1380. doi: 10.7507/1672-2531.20160208 Copy

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2.	Morrow M. Progress in the surgical management of breast cancer:Present and future. Breast, 2015, 24 (Suppl 2):S2-5.
3.	Gherghe M, Bordea C, Blidaru A. Sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer. J Med Life, 2015, 8(2):176-180.
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10.	Hwang SO, Lee SW, Kim HJ, et al. The Comparative Study of Ultrasonography, Contrast-Enhanced MRI, and F-18-FDG PET/CT for Detecting Axillary Lymph Node Metastasis in T1 Breast Cancer. J Breast Cancer, 2013, 16(3):315-321.
11.	Schopp JG, Whitman GJ. Adding MRI to ultrasound and ultrasound-guided fine-needle aspiration reduces the false-negative rate of axillary lymph node metastasis diagnosis in breast cancer patients. Breast Dis, 2016, 27(2):128-129.
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15.	谢四梅, 张安秦, 朱彩霞, 等. 触诊及影像学检查对乳腺癌腋淋巴结转移状况预测价值探讨. 中华肿瘤防治杂志, 2014, 21(15):1179-1183.
16.	殷正昕, 沈坤炜, 李亚芬, 等. 术前乳腺B超及MRI检查对乳腺癌患者腋窝淋巴结状态评估的准确性. 中华普通外科杂志, 2013, 28(4):259-262.
17.	吕涛, 吕晓玉, 汪湍, 等. 超声与钼靶摄片对乳腺癌早期诊断的意义. 中国普通外科杂志, 2013, 22(11):1414-1419.
18.	Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol, 2007, 25(24):3657-3663.
19.	Herold CJ, Lewin JS, Wibmer AG, et al. Imaging in the Age of Precision Medicine:Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology. Radiology, 2016, 279(1):226-238.
20.	李幼平, 李静, 孙鑫, 等. 循证医学在中国的发展:回顾与展望. 兰州大学学报(医学版), 2016, 42(01):25-28.
21.	陈耀龙, 杨克虎, 田金徽, 等. 循证实践指南的制定:国际经验与中国实践. 兰州大学学报(医学版), 2016, 42(01):29-35.
22.	周俊文, 马翔, 翟所迪. 如何认识和解读Meta分析. 兰州大学学报(医学版), 2016, 42(1):36-41.
23.	田金徽, 陈耀龙, 杨克虎, 等. SR/MA研究进展与挑战. 兰州大学学报(医学版), 2016, 42(01):42-47.
24.	Tackmann R, Schuetz G, Hamm B, et al. Quality of the reporting of diagnostic accuracy studies:STARD (Standards for the Reporting of Diagnostic accuracy studies). RoFo, 2010, 182(8):655-659.
25.	梁莉, 马立斌, 王莉莉, 等. MRI诊断乳腺癌腋窝淋巴结转移准确性的Meta分析. 中国医学影像技术, 2015, 31(11):1701-1706.
26.	赵玉玲, 王燕. 彩色多普勒超声检测乳腺癌腋窝前哨淋巴结价值的Meta分析. 中国循证医学杂志, 2014, 14(9):1077-1082.

1. Li T, Mello-Thoms C, Brennan PC. Descriptive epidemiology of breast cancer in China:incidence, mortality, survival and prevalence. Breast Cancer Res Treat, 2016, 159(3):395-406.
2. Morrow M. Progress in the surgical management of breast cancer:Present and future. Breast, 2015, 24 (Suppl 2):S2-5.
3. Gherghe M, Bordea C, Blidaru A. Sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer. J Med Life, 2015, 8(2):176-180.
4. Manca G, Rubello D, Tardelli E, et al. Sentinel Lymph Node Biopsy in Breast Cancer:Indications, Contraindications, and Controversies. Clin Nucl Med, 2016, 41(2):126-133.
5. O'Connell A. Future trends in breast cancer imaging. Int J Cancer Res Prev, 2012, 5(3-4):273-278.
6. Byon W, Kim E, Kwon J, et al. FDG-PET, MRI and USG in the assessment of axillary lymph node metastases in breast cancer. Breast, 2015, 24:S67.
7. Battaglia M BH, Egger M, et al. The Bayes Library of Diagnostic Studies and Reviews. 2nd Edition, 2002.
8. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2:a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8):529-536.
9. An YS, Lee DH, Yoon JK, et al. Diagnostic performance of F-18-FDG PET/CT, ultrasonography and MRI Detection of axillary lymph node metastasis in breast cancer patients. Nuklearmedizin, 2014, 53(3):89-94.
10. Hwang SO, Lee SW, Kim HJ, et al. The Comparative Study of Ultrasonography, Contrast-Enhanced MRI, and F-18-FDG PET/CT for Detecting Axillary Lymph Node Metastasis in T1 Breast Cancer. J Breast Cancer, 2013, 16(3):315-321.
11. Schopp JG, Whitman GJ. Adding MRI to ultrasound and ultrasound-guided fine-needle aspiration reduces the false-negative rate of axillary lymph node metastasis diagnosis in breast cancer patients. Breast Dis, 2016, 27(2):128-129.
12. You S, Kang DK, Jung YS, et al. Evaluation of lymph node status after neoadjuvant chemotherapy in breast cancer patients:comparison of diagnostic performance of ultrasound, MRI and F-18-FDG PET/CT. Br J Radiol, 2015, 88(1052):20150143.
13. 陈镇标. 术前乳腺B超及MRI检查对乳腺癌患者腋窝淋巴结状态评估的准确性评估. 影像技术, 2014(01):20-1, 17.
14. 刘蓉, 马兴英, 许达, 等. 彩超结合核磁共振对乳腺癌淋巴结转移的诊断价值. 西南国防医药, 2015, 25(7):753-757.
15. 谢四梅, 张安秦, 朱彩霞, 等. 触诊及影像学检查对乳腺癌腋淋巴结转移状况预测价值探讨. 中华肿瘤防治杂志, 2014, 21(15):1179-1183.
16. 殷正昕, 沈坤炜, 李亚芬, 等. 术前乳腺B超及MRI检查对乳腺癌患者腋窝淋巴结状态评估的准确性. 中华普通外科杂志, 2013, 28(4):259-262.
17. 吕涛, 吕晓玉, 汪湍, 等. 超声与钼靶摄片对乳腺癌早期诊断的意义. 中国普通外科杂志, 2013, 22(11):1414-1419.
18. Lucci A, McCall LM, Beitsch PD, et al. Surgical complications associated with sentinel lymph node dissection (SLND) plus axillary lymph node dissection compared with SLND alone in the American College of Surgeons Oncology Group Trial Z0011. J Clin Oncol, 2007, 25(24):3657-3663.
19. Herold CJ, Lewin JS, Wibmer AG, et al. Imaging in the Age of Precision Medicine:Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology. Radiology, 2016, 279(1):226-238.
20. 李幼平, 李静, 孙鑫, 等. 循证医学在中国的发展:回顾与展望. 兰州大学学报(医学版), 2016, 42(01):25-28.
21. 陈耀龙, 杨克虎, 田金徽, 等. 循证实践指南的制定:国际经验与中国实践. 兰州大学学报(医学版), 2016, 42(01):29-35.
22. 周俊文, 马翔, 翟所迪. 如何认识和解读Meta分析. 兰州大学学报(医学版), 2016, 42(1):36-41.
23. 田金徽, 陈耀龙, 杨克虎, 等. SR/MA研究进展与挑战. 兰州大学学报(医学版), 2016, 42(01):42-47.
24. Tackmann R, Schuetz G, Hamm B, et al. Quality of the reporting of diagnostic accuracy studies:STARD (Standards for the Reporting of Diagnostic accuracy studies). RoFo, 2010, 182(8):655-659.
25. 梁莉, 马立斌, 王莉莉, 等. MRI诊断乳腺癌腋窝淋巴结转移准确性的Meta分析. 中国医学影像技术, 2015, 31(11):1701-1706.
26. 赵玉玲, 王燕. 彩色多普勒超声检测乳腺癌腋窝前哨淋巴结价值的Meta分析. 中国循证医学杂志, 2014, 14(9):1077-1082.

Chinese Journal of Evidence-Based Medicine

Diagnostic Value of MRI combined with Ultrasound for Lymph Node in Breast Cancer: A Meta-analysis

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