Diagnostic value of multiple ultrasound diagnostic techniques for axillary lymph node metastases in breast cancer: A systematic analysis and network meta-analysis

Abstract

BackgroundEarly diagnosis of axillary lymph node metastasis is very important for the recurrence and prognosis of breast cancer. Currently, Lymph node biopsy is one of the important methods to detect lymph node metastasis in breast cancer, however, its invasiveness might bring complications to patients. Therefore, this study investigated the diagnostic performance of multiple ultrasound diagnostic methods for axillary lymph node metastasis of breast cancer.Materials and methodsIn this study, we searched PubMed, Web of Science, CNKI and Wan Fang databases, conducted Bayesian network meta-analysis (NMA) on the studies that met the inclusion criteria, and evaluated the consistency of five different ultrasound imaging techniques in axillary lymph node metastasis of breast cancer. Funnel graph was used to evaluate whether it had publication bias. The diagnostic performance of each ultrasound imaging method was ranked using SUCRAResultsA total of 22 papers were included, US+CEUS showed the highest SUCRA values in terms of sensitivity (SEN) (0.874), specificity (SPE) (0.911), positive predictive value (PPV) (0.972), negative predictive value (NPV) (0.872) and accuracy (ACC) (0.990).ConclusionIn axillary lymph node metastasis of breast cancer, the US+CEUS combined diagnostic method showed the highest SUCRA value among the five ultrasound diagnostic methods. This study provides a theoretical basis for preoperative noninvasive evaluation of axillary lymph node metastases in breast cancer patients and clinical treatment decisions.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022351977.

Assessment of the axilla in women with early-stage breast cancer undergoing primary surgery: a review

“…A systematic review showed a pooled sensitivity of 54% and specificity of 100% in identifying positive axillary nodes by this technique [80]. Adding shear wave elastography to conventional ultrasound improves the accuracy but is still inferior to the CEUS results [81]. A dedicated MRI assessment may have the required negative predictive value and sensitivity.…”

Axillary surgery in the case of limited involved axillary lymph nodes

“…We strongly believe that with an FNR of up to 45% ( 7 ) palpation alone as performed in the ACOSOG Z0011 trial is inadequate. Axillary ultrasound can be an extremely helpful tool in the diagnostic work-up of the axilla before therapy ( 8 ) and yields negative predictive values up to 20% ( 9 ). However, even in adequately staged patients including ultrasound the rate of clinically occult sentinel node metastases is—depending on the tumor biology and the use of neoadjuvant treatment—up to 39.7% ( 10 , 11 ), there are even reports about gross nodal disease not detected before surgery and diagnosed by computed tomography for planning the radiation therapy ( 12 ).…”