Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.
Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
Ann Surg. 2021 Apr 1;273(4):694-700. doi: 10.1097/SLA.0000000000004356.
The purpose of this study was to perform a systematic review and meta-analysis to determine the diagnostic performance of current noninvasive imaging modalities for assessment of axillary response after neoadjuvant systemic therapy (NST) in clinically node-positive breast cancer patients.
NST can lead to downstaging of axillary lymph node disease. Imaging can potentially provide information about the axillary response to NST and, consequently, tailor the surgical management.
PubMed and Embase were searched for studies that compared noninvasive imaging after NST with axillary surgery outcome to identify axillary response in patients with initial pathologically proven axillary lymph node metastasis. Two reviewers independently screened the studies and extracted the data. A meta-analysis was performed by computing the pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Thirteen studies describing 2380 patients were included for final analysis. Of these patients, 1322 had undergone axillary ultrasound, 849 breast MRI, and 209 whole-body 18F-FDG PET-CT. The overall axillary pathologic complete response rate was 39.5% (941/2380). For axillary ultrasound, the pooled sensitivity, specificity, PPV, and NPV were 65%, 69%, 77%, 50%, respectively. For breast MRI, the pooled sensitivity, specificity, PPV, and NPV were 60%, 76%, 78%, 58%, respectively. For whole-body 18F-FDG PET-CT, the pooled sensitivity, specificity, PPV, and NPV were 38%, 86%, 78%, 49%, respectively.
The diagnostic performance of current noninvasive imaging modalities is limited to accurately assess axillary response after NST in clinically node-positive breast cancer patients.
本研究旨在进行系统评价和荟萃分析，以确定当前非侵入性成像方式在评估临床淋巴结阳性乳腺癌患者新辅助全身治疗（NST）后腋窝反应的诊断性能。
NST 可导致腋窝淋巴结疾病降级。成像技术可能提供有关 NST 后腋窝反应的信息，并相应地调整手术管理。
在 PubMed 和 Embase 上搜索比较 NST 后非侵入性成像与腋窝手术结果的研究，以确定初始病理证实腋窝淋巴结转移患者的腋窝反应。两名审查员独立筛选研究并提取数据。通过计算汇总敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）来进行荟萃分析。
共有 13 项研究描述了 2380 名患者，最终纳入分析。这些患者中，1322 人接受了腋窝超声检查，849 人接受了乳腺 MRI 检查，209 人接受了全身 18F-FDG PET-CT 检查。腋窝病理完全缓解率总体为 39.5%（941/2380）。对于腋窝超声，汇总敏感性、特异性、PPV 和 NPV 分别为 65%、69%、77%、50%。对于乳腺 MRI，汇总敏感性、特异性、PPV 和 NPV 分别为 60%、76%、78%、58%。对于全身 18F-FDG PET-CT，汇总敏感性、特异性、PPV 和 NPV 分别为 38%、86%、78%、49%。
目前的非侵入性成像方式的诊断性能有限，无法准确评估临床淋巴结阳性乳腺癌患者 NST 后的腋窝反应。
