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Diagnostic performance of MRI for assessing axillary lymph node status after neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis

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Abstract

Objective

This systematic review examined the diagnostic performance of magnetic resonance imaging (MRI) for assessing axillary lymph node status (ALNS) after neoadjuvant chemotherapy (NAC) in breast cancer patients.

Methods

We searched PubMed, Embase, Cochrane Library, and Web of Science to identify relevant studies and used the QUADAS-2 tool to assess methodological quality of eligible studies. We used STATA version 12.0 to perform data pooling, heterogeneity testing, subgroup analysis, and sensitivity analysis.

Results

For the 21 enrolled studies, including 2875 patients, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were respectively 0.63 (95% CI: 0.53–0.72), 0.75 (95% CI: 0.68–0.81), 2.52 (95% CI: 1.98–3.19), 0.50 (95% CI: 0.39–0.63), and 5.08 (95% CI: 3.38–7.63). The AUC was 0.76 (95% CI: 0.72–0.79). I2 values of sensitivity (I2 = 94.41%) and specificity (I2 = 88.97%) were both > 50%. For the initial positive ALN patients, the pooled sensitivity and specificity were 0.64 (95% CI: 0.53–0.75) and 0.74 (95% CI: 0.64–0.82), respectively. Sensitivity analyses by focusing on studies with MRI performed post-NAC, studies using DCE-MRI, or studies with low risk of bias showed similar results to the primary analyses.

Conclusion

MRI may have suboptimal diagnostic value in assessing ALNS after NAC for breast cancer patients. Due to the inconsistency of NAC regimens, the variability of axillary surgery, and the lack of time interval between MRI and surgery, further studies are needed to confirm our findings.

Clinical relevance statement

Our study provided the diagnostic value of MRI in assessing axillary lymph node status after neoadjuvant chemotherapy for breast cancer patients.

Key Points

• MRI may have suboptimal diagnostic value in assessing axillary lymph node status after NAC for general breast cancer patients.

• The initial axillary lymph node status has little impact on the diagnostic efficacy of MRI.

• The substantial heterogeneity among studies highlights the need for further studies to provide more high-quality evidence in this field.

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Abbreviations

ALNS:

Axillary lymph node status

DOR:

Diagnostic odds ratio

MRI:

Magnetic resonance imaging

NAC:

Neoadjuvant chemotherapy

NLR:

Negative likelihood ratio

PLR:

Positive likelihood ratio

PRISMA-DTA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies

QUADAS-2:

Quality Assessment of Diagnostic Accuracy Studies-2

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, China

    Zhifan Li, Qinqin Ma, Mengmeng Qu, Jinkui Li & Junqiang Lei

  2. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China

    Ya Gao

  3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Ya Gao

  4. Department of Radiology, the First Hospital of Lanzhou University, Chengguan District, No. 1 Donggang West Road, Lanzhou, 730000, Gansu Province, China

    Jinkui Li & Junqiang Lei

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Correspondence to Junqiang Lei.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Written informed consent was not required for this study because it is a meta-analysis

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Li, Z., Ma, Q., Gao, Y. et al. Diagnostic performance of MRI for assessing axillary lymph node status after neoadjuvant chemotherapy in breast cancer: a systematic review and meta-analysis. Eur Radiol 34, 930–942 (2024). https://doi.org/10.1007/s00330-023-10155-8

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