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.
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.
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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.
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.	陳鎮標. 術前乳腺B超及MRI檢查對乳腺癌患者腋窩淋巴結狀態評估的準確性評估. 影像技術, 2014(01):20-1, 17.
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15.	謝四梅, 張安秦, 朱彩霞, 等. 觸診及影像學檢查對乳腺癌腋淋巴結轉移狀況預測價值探討. 中華腫瘤防治雜志, 2014, 21(15):1179-1183.
16.	殷正昕, 沈坤煒, 李亞芬, 等. 術前乳腺B超及MRI檢查對乳腺癌患者腋窩淋巴結狀態評估的準確性. 中華普通外科雜志, 2013, 28(4):259-262.
17.	呂濤, 呂曉玉, 汪湍, 等. 超聲與鉬靶攝片對乳腺癌早期診斷的意義. 中國普通外科雜志, 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, 李靜, 孫鑫, 等. 循證醫學在中國的發展:回顧與展望. 蘭州大學學報(醫學版), 2016, 42(01):25-28.
21.	陳耀龍, 楊克虎, 田金徽, 等. 循證實踐指南的制定:國際經驗與中國實踐. 蘭州大學學報(醫學版), 2016, 42(01):29-35.
22.	周俊文, 馬翔, 翟所迪. 如何認識和解讀Meta分析. 蘭州大學學報(醫學版), 2016, 42(1):36-41.
23.	田金徽, 陳耀龍, 楊克虎, 等. SR/MA研究進展與挑戰. 蘭州大學學報(醫學版), 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, 馬立斌, 王莉莉, 等. MRI診斷乳腺癌腋窩淋巴結轉移準確性的Meta分析. 中國醫學影像技術, 2015, 31(11):1701-1706.
26.	趙玉玲, 王燕. 彩色多普勒超聲檢測乳腺癌腋窩前哨淋巴結價值的Meta分析. 中國循證醫學雜志, 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. 陳鎮標. 術前乳腺B超及MRI檢查對乳腺癌患者腋窩淋巴結狀態評估的準確性評估. 影像技術, 2014(01):20-1, 17.
14. 劉蓉, 馬興英, 許達, 等. 彩超結合核磁共振對乳腺癌淋巴結轉移的診斷價值. 西南國防醫藥, 2015, 25(7):753-757.
15. 謝四梅, 張安秦, 朱彩霞, 等. 觸診及影像學檢查對乳腺癌腋淋巴結轉移狀況預測價值探討. 中華腫瘤防治雜志, 2014, 21(15):1179-1183.
16. 殷正昕, 沈坤煒, 李亞芬, 等. 術前乳腺B超及MRI檢查對乳腺癌患者腋窩淋巴結狀態評估的準確性. 中華普通外科雜志, 2013, 28(4):259-262.
17. 呂濤, 呂曉玉, 汪湍, 等. 超聲與鉬靶攝片對乳腺癌早期診斷的意義. 中國普通外科雜志, 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, 李靜, 孫鑫, 等. 循證醫學在中國的發展:回顧與展望. 蘭州大學學報(醫學版), 2016, 42(01):25-28.
21. 陳耀龍, 楊克虎, 田金徽, 等. 循證實踐指南的制定:國際經驗與中國實踐. 蘭州大學學報(醫學版), 2016, 42(01):29-35.
22. 周俊文, 馬翔, 翟所迪. 如何認識和解讀Meta分析. 蘭州大學學報(醫學版), 2016, 42(1):36-41.
23. 田金徽, 陳耀龍, 楊克虎, 等. SR/MA研究進展與挑戰. 蘭州大學學報(醫學版), 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, 馬立斌, 王莉莉, 等. MRI診斷乳腺癌腋窩淋巴結轉移準確性的Meta分析. 中國醫學影像技術, 2015, 31(11):1701-1706.
26. 趙玉玲, 王燕. 彩色多普勒超聲檢測乳腺癌腋窩前哨淋巴結價值的Meta分析. 中國循證醫學雜志, 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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