Browse > Article
http://dx.doi.org/10.7314/APJCP.2012.13.11.5517

Diagnostic Accuracy of Ultrasonograph Guided Fine-needle Aspiration Cytologic in Staging of Axillary Lymph Node Metastasis in Breast Cancer Patients: a Meta-analysis  

Wang, Xi-Wen (Bao'an Maternal and Child Health Hospital)
Xiong, Yun-Hui (Fuyong People's Hospital)
Zen, Xiao-Qing (Bao'an Maternal and Child Health Hospital)
Lin, Hai-Bo (Bao'an Maternal and Child Health Hospital)
Liu, Qing-Yi (Bao'an Maternal and Child Health Hospital)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.13, no.11, 2012 , pp. 5517-5523 More about this Journal
Abstract
Purpose: 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.Methods: 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). Results: 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. Conclusion: 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.
Keywords
Breast cancer; USG-FNAC; meta-analysis; sensitivity; specificity;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Adler LP, Crowe JP, Al-Kaisi NK, et al (1993). Evaluation of breast masses and axillary lymph nodes with [F-18] 2-deoxy-2-fluoro- D-glucose PET. Radiology, 187, 743-50   DOI
2 Alkuwari E, Auger M (2008). Accuracy of fine-needle aspiration cytology of axillary lymph nodes in breast cancer patients: a study of 115 cases with cytologic-histologic correlation. Cancer, 114, 89-93.   DOI
3 Altomare V, Guerriero G, Carino R, et al (2007). Axillary lymph node echo-guided fine-needle aspiration cytology enables breast cancer patients to avoid a sentinel lymph node biopsy. Preliminary experience and a review of the literature. Surg Today, 37, 735-9.   DOI
4 Baruah BP, Goyal A, Young P, et al (2010). Axillary node staging by ultrasonography and fine-needle aspiration cytology in patients with breast cancer. Br J Surg, 97, 680-3.   DOI
5 Bedrosian I, Bedi D, Kuerer HM, et al (2003). Impact of clinicopathological factors on sensitivity of axillary ultrasonography in the detection of axillary nodal metastases in patients with breast cancer. Ann Surg Oncol, 10, 1025-30.   DOI
6 Begg CB (1987). Biases in the assessment of diagnostic tests. Stat Med, 6, 411-23.   DOI
7 Bonnema J, van Geel AN, van Ooijen B, et al (1997) .Ultrasoundguided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method. World J Surg, 21, 270-4.   DOI
8 Carroll PA, O'Mahony D, McDermott R, et al (2011). Perioperative diagnosis of the positive axilla in breast cancer: a safe, time efficient algorithm. Eur J Surg Oncol, 37, 205-10.   DOI
9 Ciatto S, Brancato B, Risso G, et al (2007). Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat, 103, 85-91.   DOI   ScienceOn
10 De Freitas R Jr, Costa MV, Schneider SV, et al (1991). Accuracy of ultrasound and clinical examination in the diagnosis of axillary lymph node metastasis in breast cancer. Eur J Surg Oncol, 17, 240-4.
11 Devaraj S, Iqbal M, Donnelly J, et al (2011).Axillary ultrasound in invasive breast cancer: experience of our surgeons. Breast J, 17,191-5.   DOI
12 de Kanter AY, van Eijck CH, van Geel AN, et al (1999). Multicentre study of ultrasonographically guided axillary node biopsy in patients with breast cancer. Br J Surg, 86, 1459-62   DOI
13 DerSimonian R, Laird N (1986). Meta-analysis in clinical trials. Control Clin Trials, 7, 177-88.   DOI
14 Deurloo EE, Tanis PJ, Gilhuijs KG, et al (2003). Reduction in the number of sentinel lymph node procedures by preoperative ultrasonography of the axilla in breast cancer. Eur J Cancer, 39, 1068-73.   DOI   ScienceOn
15 Duchesne N, Jaffey J, Florack P, et al (2005). Redefining ultrasound appearance criteria of positive axillary lymph nodes. Can Assoc Radiol J, 56, 289-96.
16 Fisher B, Bauer M, Wickerham D, et al (1983). Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer: an NSABP update. Cancer, 52, 1551-7   DOI   ScienceOn
17 Fisher ER, Anderson S, Redmond C, et al (1993). Pathologic findings from the national surgical adjuvant breast project protocol B-06. 10- year pathologic and clinical prognostic discriminants. Cancer, 71, 2507-24.   DOI   ScienceOn
18 Glas AS, Lijmer JG, Prins MH, et al (2003). The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol, 56, 1129-35.   DOI   ScienceOn
19 Hayes BD, Feeley L, Quinn CM, et al (2011). Axillary fine needle aspiration cytology for pre-operative staging of patients with screen-detected invasive breast carcinoma. J Clin Pathol, 64, 338-42.   DOI
20 Herrada J, Iyer RB, Atkinson EN, et al (1997). Relative value of physical examination, mammography, and breast sonography in evaluating the size of the primary tumor and regional lymph node metastasiss in women receiving neoadjuvant chemotherapy for locally advanced breast carcinoma. Clin Cancer Res, 3, 1565-9.
21 Higgins J, Thompson S, Deeks J, et al (2003) .Measuring inconsistency in meta-analyses. Br Med J, 327, 557-60.   DOI   ScienceOn
22 Irwig L, Macaskill P, Glasziou P, et al (1995). Meta-analytic methods for diagnostic test accuracy. J Clin Epidemiol, 48, 119-30.   DOI   ScienceOn
23 Jung J, Park H, Park J, et al (2010). Accuracy of preoperative ultrasound and ultrasound-guided fine needle aspiration cytology for axillary staging in breast cancer. ANZ J Surg, 80, 271-5.   DOI   ScienceOn
24 Kissin MW, Querci della Rovere G, Easton D, et al (1986). Risk of lymphoedema following the treatment of breast cancer. Br J Surg, 73, 580-4.   DOI   ScienceOn
25 Krishnamurthy S, Sneige N, Bedi DG, et al (2002). Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer, 95, 982-8.   DOI   ScienceOn
26 Krishnamurthy S, Sneige N, Bedi DG, et al (2002). Role of ultrasound-guided fine-needle aspiration of indeterminate and suspicious axillary lymph nodes in the initial staging of breast carcinoma. Cancer, 95, 982-8.   DOI   ScienceOn
27 Kuenen-Boumeester V, Menke-Pluymers M, de Kanter AY, et al (2003). Ultrasound-guided fine needle aspiration cytology of axillary lymph nodes in breast cancer patients. A preoperative staging procedure. Eur J Cancer, 39, 170-4.   DOI   ScienceOn
28 Moses LE, Shapiro D, Littenberg B (1993). Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med, 12, 1293-316.   DOI
29 Lotze MT, Duncan MA (1981). Gerber LH, Woltering EA, Rosenberg SA. Early versus delayed shoulder motion following axillary dissection: a randomized prospective study. Ann Surg, 193, 288-95.   DOI
30 Luparia A, Campanino P, Cotti R, et al (2010). Role of axillary ultrasound in the preoperative diagnosis of lymph node metastases in patients affected by breast carcinoma. Radiol Med, 115, 225-37.   DOI
31 Pamilo M, Soiva M, Lavast EM (1989). Real time ultrasound, axillary mammography and clinical examination in the detection of axillary lymph node metastasiss in breast cancer patients. J Ultrasound Med, 8, 115-20.   DOI
32 Parkin DM, Bray F, Ferlay J, et al (2005). Global cancer statistics, 2002. Ca Cancer J Clin, 55, 74-108.   DOI   ScienceOn
33 Podkrajsek M, Music MM, Kadivec M, et al (2005). Role of ultrasound in the preoperative staging of patients with breast cancer. Eur Radiol, 15, 1044-50.   DOI   ScienceOn
34 Popli MB, Sahoo M, Mehrotra N, et al (2006). Preoperative ultrasound-guided fine-needle aspiration cytology for axillary staging in breast carcinoma. Australas Radiol, 50, 122-6.   DOI   ScienceOn
35 Sacre RA (1986). Clinical evaluation of axillary lymph nodes compared to surgical and pathological findings. Eur J Surg Oncol, 12, 169-73.
36 Samphao S, Eremin JM, El-Sheemy M, et al (2008). Management of the axilla in women with breast cancer: current clinical practice and a new selective targeted approach. Ann Surg Oncol, 15, 1282-96.   DOI
37 Shaw JH, Rumball EM (1990). Complications and local recurrence following lymphadenectomy. Br J Surg, 77, 760-4.   DOI
38 Sapino A, Cassoni P, Zanon E, et al (2003). Ultrasonographicallyguided fine-needle aspiration of axillary lymph nodes: role in breast cancer management. Br J Cancer, 88, 702-6.   DOI   ScienceOn
39 Schiettecatte A, Bourgain C, Breucq C, et al (2011). Initial axillary staging of breast cancer using ultrasound-guided fine needle aspiration: a liquid-based cytology study. Cytopathology, 22, 30-5.   DOI
40 Schwartz GF, Giuliano AE, Veronesi U (2002). Proceedings of the consensus conference on the role of sentinel lymph node biopsy in carcinoma of the breast, April 19-22, 2001, Philadelphia, Pennsylvania. Cancer, 94, 2542-51.   DOI
41 Song F, Khan KS, Dinnes J, et al (2002). Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy. Int J Epidemiol, 31, 88-95.   DOI
42 Tahir M, Osman KA, Shabbir J, et al (2008). Preoperative axillary staging in breast cancer-saving time and resources. Breast J, 14, 369-71.   DOI
43 van Rijk MC, Deurloo EE, Nieweg OE, et al (2006). Ultrasonography and fine-needle aspiration cytology can spare breast cancer patients unnecessary sentinel lymph node biopsy. Ann Surg Oncol, 13, 31-5.   DOI   ScienceOn
44 vens D, Hoe AL, Podd TJ, et al (1992). Assessment of morbidity from complete axillary dissection. Br J Cancer, 66, 136-8.   DOI
45 Whiting P, Rutjes AW, Reitsma JB, et al (2003). The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol, 3, 25.
46 Zamora J, Abraira V, Muriel A, et al (2006). Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol, 6, 31.   DOI
47 Whiting P, Weswood ME, Rutjes AW, et al (2006). Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies (update). BMC Med Res Methodol, 6, 9.   DOI   ScienceOn