Abstract
To evaluate the diagnostic accuracy of ultrasonograph and fine-needle aspiration cytologic examination (USG-FNAC) in the staging of axillary lymph node metastasis in breast cancer patients. We conducted an electronic search of the literature addressing the performance of USG-FNAC in diagnosis of axillary lymph node metastasis in databases such as Pubmed, Medline, Embase, Ovid and Cochrane library. We introduced a series of diagnostic test indices to evaluate the performance of USG-FNAC by the random effect model (REM), including sensitivity, specificity, likelihood ratios, and diagnostic odds ratios and area under the curve (AUC). A total of 20 studies including 1371 cases and 1289 controls were identified. The pooled sensitivity was determined to be 0.66 (95% CI 0.64-0.69), specificity 0.98 (95% CI 0.98-0.99), positive likelihood ratio 22.7 (95% CI 15.0-34.49), negative likelihood ratio 0.32 (95% CI 0.25-0.41), diagnostic OR 84.2 (95% CI 53.3-133.0). Due to the marginal threshold effect found in some indices of diagnostic validity, we used a summary SROC curve to aggregate data, and obtained a symmetrical curve with an AUC of 0.942. The results of this meta-analysis indicated that the USG-FNAC techniques have acceptable diagnostic validity indices and can be used for early staging of axillary lymph node in breast cancer patients.
Highlights
In the developed countries, breast cancer is one of the most common modalities of malignancy in women and the global incidence of breast cancer is still increasing (Parkin et al, 2005)
We introduced a series of diagnostic test indices to evaluate the performance of USG-FNAC by the random effect model (REM), including sensitivity, specificity, likelihood ratios, and diagnostic odds ratios and area under the curve (AUC)
Only 21 of 44 articles satisfied the requirements of the meta-analysis fully (Bonnema et al, 1997; Krishnamurthy et al, 2002; Bedrosian et al, 2003; Deurloo et al, 2003; Kuenen-Boumeester et al, 2003; Sapino et al, 2003; Duchesne et al, 2005; Podkrajsek et Publication bias An estimate of potential publication bias was obtained using a Begg funnel plot, in which the standard error of log (DOR) for each study was plotted against its log (OR)
Summary
Breast cancer is one of the most common modalities of malignancy in women and the global incidence of breast cancer is still increasing (Parkin et al, 2005). The diagnosis of the axillary lymph node metastasis status possesses great priority in the treatment of breast cancer. Clinical examination alone is neither a sensitive nor reliable way to ascertain lymph node status, because metastatic lymph nodes are often impalpable and reactive lymph nodes may be mistaken for metastasis (Sacre , 1983; Pamilo et al, 1989; De Freitas et al, 1991). The accuracy of preoperative ultrasonographic diagnosis of nodal metastasis has improved with the development of high-frequency ultrasonography technology. Axillary ultrasonography is increasingly being used to improve the staging of breast cancer patients who have negative axillary lymph nodes on physical examination (Herrada et al, 1997; de Kanter et al, 1999). Due to overlapping sonographic features of benign/reactive and suspicious/ metastatic lymph nodes, the value of ultrasonography in the diagnosis of lymph nodes metastasiss had been discounted
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