Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Department of Genetics, Stanford University, Stanford, CA, USA.
Korean J Radiol. 2023 Aug;24(8):739-751. doi: 10.3348/kjr.2022.0846.
This systematic review and meta-analysis evaluated the accuracy of preoperative breast magnetic resonance imaging (MRI) features and tumor-to-nipple distance (TND) for diagnosing occult nipple-areolar complex (NAC) involvement in breast cancer.
The MEDLINE, Embase, and Cochrane databases were searched for articles published until March 20, 2022, excluding studies of patients with clinically evident NAC involvement or those treated with neoadjuvant chemotherapy. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Two reviewers independently evaluated studies that reported the diagnostic performance of MRI imaging features such as continuity to the NAC, unilateral NAC enhancement, non-mass enhancement (NME) type, mass size (> 20 mm), and TND. Summary estimates of the sensitivity and specificity curves and the summary receiver operating characteristic (SROC) curve of the MRI features for NAC involvement were calculated using random-effects models. We also calculated the TND cutoffs required to achieve predetermined specificity values.
Fifteen studies (n = 4002 breast lesions) were analyzed. The pooled sensitivity and specificity (with 95% confidence intervals) for NAC involvement diagnosis were 71% (58-81) and 94% (91-96), respectively, for continuity to the NAC; 58% (45-70) and 97% (95-99), respectively, for unilateral NAC enhancement; 55% (46-64) and 83% (75-88), respectively, for NME type; and 88% (68-96) and 58% (40-75), respectively, for mass size (> 20 mm). TND had an area under the SROC curve of 0.799 for NAC involvement. A TND of 11.5 mm achieved a predetermined specificity of 85% with a sensitivity of 64%, and a TND of 12.3 mm yielded a predetermined specificity of 83% with a sensitivity of 65%.
Continuity to the NAC and unilateral NAC enhancement may help predict occult NAC involvement in breast cancer. To achieve the desired diagnostic performance with TND, a suitable cutoff value should be considered.
本系统评价和荟萃分析评估了术前乳腺磁共振成像（MRI）特征和肿瘤至乳头距离（TND）在诊断乳腺癌隐匿性乳头乳晕复合体（NAC）受累中的准确性。
检索 MEDLINE、Embase 和 Cochrane 数据库，截至 2022 年 3 月 20 日，排除临床可见 NAC 受累或接受新辅助化疗的患者的研究。使用诊断准确性研究质量评估工具 2 评估报告 MRI 成像特征（如与 NAC 的连续性、单侧 NAC 增强、非肿块强化（NME）类型、肿块大小（>20mm）和 TND）诊断性能的研究质量。使用随机效应模型计算 MRI 特征对 NAC 受累的敏感性和特异性曲线以及汇总受试者工作特征（SROC）曲线的汇总估计值。我们还计算了达到预定特异性值所需的 TND 截止值。
分析了 15 项研究（n=4002 个乳腺病变）。NAC 受累诊断的 TND 汇总敏感性和特异性（95%置信区间）分别为 71%（58-81）和 94%（91-96），用于连续性至 NAC；分别为 58%（45-70）和 97%（95-99），用于单侧 NAC 增强；分别为 55%（46-64）和 83%（75-88），用于 NME 类型；分别为 88%（68-96）和 58%（40-75），用于肿块大小（>20mm）。TND 在 SROC 曲线下面积为 0.799，用于 NAC 受累。TND 为 11.5mm 时，特异性为 85%，敏感性为 64%；TND 为 12.3mm 时，特异性为 83%，敏感性为 65%。
与 NAC 的连续性和单侧 NAC 增强可能有助于预测乳腺癌隐匿性 NAC 受累。为了达到 TND 的预期诊断性能，应考虑合适的截止值。
