Morwenn Le Boulc'h1, Julia Gilhodes2, Zara Steinmeyer3, Sébastien Molière4, Carole Mathelin5. 1. Department of Oncologic Radiology, Claudius Regaud Institute, Institut Universitaire du Cancer de Toulouse-Oncopole, 31100 Toulouse, France. 2. Clinical Trials, Institut Universitaire du Cancer de Toulouse-Oncopole, 31100 Toulouse, France. 3. Internal Medicine and Oncogeriatry Unit, Geriatric Department, University Hospital, Place du Docteur Baylac, CEDEX 9, 31059 Toulouse, France. 4. Department of Women's Imaging, University Hospitals of Strasbourg, 67200 Strasbourg, France. 5. Surgery at ICANS Cancer Institute (Institute of Cancerology Strasbourg Europe), CEDEX, 67033 Strasbourg, France.
Abstract
BACKGROUND: This systematic review aimed at comparing performances of ultrasonography (US), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (PET) for axillary staging, with a focus on micro- or micrometastases. METHODS: A search for relevant studies published between January 2002 and March 2018 was conducted in MEDLINE database. Study quality was assessed using the QUality Assessment of Diagnostic Accuracy Studies checklist. Sensitivity and specificity were meta-analyzed using a bivariate random effects approach; Results: Across 62 studies (n = 10,374 patients), sensitivity and specificity to detect metastatic ALN were, respectively, 51% (95% CI: 43-59%) and 100% (95% CI: 99-100%) for US, 83% (95% CI: 72-91%) and 85% (95% CI: 72-92%) for MRI, and 49% (95% CI: 39-59%) and 94% (95% CI: 91-96%) for PET. Interestingly, US detects a significant proportion of macrometastases (false negative rate was 0.28 (0.22, 0.34) for more than 2 metastatic ALN and 0.96 (0.86, 0.99) for micrometastases). In contrast, PET tends to detect a significant proportion of micrometastases (true positive rate = 0.41 (0.29, 0.54)). Data are not available for MRI. CONCLUSIONS: In comparison with MRI and PET Fluorodeoxyglucose (FDG), US is an effective technique for axillary triage, especially to detect high metastatic burden without upstaging majority of micrometastases.
BACKGROUND: This systematic review aimed at comparing performances of ultrasonography (US), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (PET) for axillary staging, with a focus on micro- or micrometastases. METHODS: A search for relevant studies published between January 2002 and March 2018 was conducted in MEDLINE database. Study quality was assessed using the QUality Assessment of Diagnostic Accuracy Studies checklist. Sensitivity and specificity were meta-analyzed using a bivariate random effects approach; Results: Across 62 studies (n = 10,374 patients), sensitivity and specificity to detect metastatic ALN were, respectively, 51% (95% CI: 43-59%) and 100% (95% CI: 99-100%) for US, 83% (95% CI: 72-91%) and 85% (95% CI: 72-92%) for MRI, and 49% (95% CI: 39-59%) and 94% (95% CI: 91-96%) for PET. Interestingly, US detects a significant proportion of macrometastases (false negative rate was 0.28 (0.22, 0.34) for more than 2 metastatic ALN and 0.96 (0.86, 0.99) for micrometastases). In contrast, PET tends to detect a significant proportion of micrometastases (true positive rate = 0.41 (0.29, 0.54)). Data are not available for MRI. CONCLUSIONS: In comparison with MRI and PET Fluorodeoxyglucose (FDG), US is an effective technique for axillary triage, especially to detect high metastatic burden without upstaging majority of micrometastases.
Entities:
Keywords:
breast cancer; lymph node; magnetic resonance imaging; meta-analysis; micrometastasis; positron emission tomography; ultrasound
Authors: Nina Ditsch; Achim Wöcke; Michael Untch; Christian Jackisch; Ute-Susann Albert; Maggie Banys-Paluchowski; Ingo Bauerfeind; Jens-Uwe Blohmer; Wilfried Budach; Peter Dall; Eva Maria Fallenberg; Peter A Fasching; Tanja N Fehm; Michael Friedrich; Bernd Gerber; Oleg Gluz; Nadia Harbeck; Jörg Heil; Jens Huober; Hans H Kreipe; David Krug; Thorsten Kühn; Sherko Kümmel; Cornelia Kolberg-Liedtke; Sibylle Loibl; Diana Lüftner; Michael Patrick Lux; Nicolai Maass; Christoph Mundhenke; Ulrike Nitz; Tjoung-Won Park-Simon; Toralf Reimer; Kerstin Rhiem; Achim Rody; Marcus Schmidt; Andreas Schneeweiss; Florian Schütz; Hans-Peter Sinn; Christine Solbach; Erich-Franz Solomayer; Elmar Stickeler; Christoph Thomssen; Isabell Witzel; Volkmar Müller; Wolfgang Janni; Marc Thill Journal: Breast Care (Basel) Date: 2022-05-05 Impact factor: 2.268