Jun Wei, Cong Wang, Xianxin Xie, Daqing Jiang
Am Surg. 2019 Jun 1;85(6):645-653.
The purpose of this meta-analysis was to determine the value of quantitative dynamic contrast-enhanced (DCE) MRI (DCE-MRI) in evaluating the response of breast cancer to neoadjuvant chemotherapy (NAC). PubMed, Embase, and Cochrane Library databases (from building to July 31, 2018) were searched to collect articles about the therapeutic evaluation of NAC using the quantitative DCE-MRI in patients with breast cancer. The sensitivities and specificities of quantitative DCE-MRI in the evaluation of NAC for breast cancer were extracted from the articles. Meta-DiSc1.4 was applied to evaluate the efficacy of the sensitivity and specificity; forest figure and summary receiver operating characteristics (SROC) were created. A total of 356 articles were enrolled in this study, including 739 cases in total, in which 218 cases were effective and the other 521 cases were ineffective to NAC, considering the pathological results as the gold standard. The sensitivity and specificity in the included 14 articles of quantitative DCE-MRI (, , and ) in comprehensively evaluating NAC for breast cancer were 84 per cent (95% confidence interval (CI): 78-88%) and 83 per cent (95% CI: 79-86%), respectively. The area under SROC was 0.899 (95% CI: 0.867-0.943). The sensitivity and specificity in the three articles of evaluating NAC for breast cancer were 84.1 per cent (95% CI: 71.0-92.1%) and 81.3 per cent (95% CI: 70.5%-88.5%), respectively. The area under SROC was 0.899 (95% CI: 0.834-0.962). Our study confirmed that the quantitative DCE-MRI is able to monitor NAC treatment for breast cancer because of its high sensitivity and specificity. However, there is a high degree of heterogeneity in published studies, highlighting the lack of standardization in the field.
本荟萃分析的目的是确定定量动态对比增强（DCE）磁共振成像（DCE-MRI）在评估乳腺癌对新辅助化疗（NAC）反应中的价值。检索了PubMed、Embase和Cochrane图书馆数据库（自建库至2018年7月31日），以收集关于使用定量DCE-MRI对乳腺癌患者进行NAC治疗评估的文章。从文章中提取定量DCE-MRI在评估乳腺癌NAC中的敏感性和特异性。应用Meta-DiSc1.4评估敏感性和特异性的疗效；绘制森林图和总结性受试者工作特征（SROC）曲线。本研究共纳入356篇文章，共计739例病例，以病理结果为金标准，其中218例对NAC有效，另外521例对NAC无效。纳入的14篇关于定量DCE-MRI（、和）综合评估乳腺癌NAC的文章中，敏感性和特异性分别为84%（95%置信区间（CI）：78-88%）和83%（95%CI：79-86%）。SROC曲线下面积为0.899（95%CI：0.867-0.943）。评估乳腺癌NAC的3篇文章中，敏感性和特异性分别为84.1%（95%CI：71.0-92.1%）和81.3%（95%CI：70.5%-88.5%）。SROC曲线下面积为0.899（95%CI：0.834-0.962）。我们的研究证实，定量DCE-MRI因其高敏感性和特异性，能够监测乳腺癌的NAC治疗。然而，已发表的研究存在高度异质性，突出了该领域缺乏标准化的问题。
