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Diagnostic value of contrast-enhanced ultrasound for sentinel lymph node metastasis in breast cancer: an updated meta-analysis

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Abstract

Purpose

The status of sentinel lymph nodes (SLN) is an important factor in determining the stage of breast cancer (BC) and the surgical procedure, and also a biomarker of the BC prognosis. This meta-analysis was performed to investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) for SLN metastasis.

Methods

A systematic search was conducted for relevant articles published in the PubMed, Embase, Web of Science, OVID databases, and Cochrane Library from inception to March 2023. We calculated the sensitivity, specificity, positive and negative likelihood ratio (PLR; NLR), diagnostic odds ratio (DOR), and summary receiver operator characteristic (SROC) curve to evaluate the diagnostic efficacy of CEUS in SLN metastasis. Subgroup analysis was also performed to investigate potential sources of heterogeneity.

Results

A total of 12 studies with 1525 patients were included in this meta-analysis. The overall pooled sensitivity and specificity of CEUS in the diagnosis of SLN metastasis were 0.91 (95% CI: 0.84–0.95) and 0.86 (95% CI: 0.78–0.92). The PLR, NLR, and DOR were 6.51 (95% CI: 4.09–10.36), 0.11 (95% CI: 0.07–0.18), and 59.43 (95% CI: 33.27–106.17), respectively, and the area under the SROC curve was determined to be 0.95 (95%CI: 0.92–0.96), all showing excellent diagnostic value. In the subgroup analysis, percutaneous CEUS was more sensitive than intravenous CEUS in the diagnosis of SLN metastases (0.92 versus 0.82, p < 0.05).

Conclusion

CEUS, especially percutaneous CEUS, is a reliable imaging technique for diagnosing SLN metastasis and providing important information in the stage management of breast cancer.

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Data availability

All data and material used in this project are publicly available in the databases listed in the manuscript.

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Funding

The work was supported by the Natural Science Foundation of Shandong Province [Grant Number ZR2021QH047] and the Clinical Science and Technology Innovation Development Program of Jinan [Grant Number 202134036].

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Authors and Affiliations

  1. Department of Ultrasound, Shandong Provincial Hospital affiliated to Shandong First Medical University, No. 324 Jing 5 Rd, Jinan, Shandong, 250021, People’s Republic of China

    Xiao Liu, Meihuan Wang, Qian Wang & Huawei Zhang

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  1. Xiao Liu
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  2. Meihuan Wang
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  3. Qian Wang
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  4. Huawei Zhang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XL, MW and QW. The first draft of the manuscript was written by XL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Qian Wang or Huawei Zhang.

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Liu, X., Wang, M., Wang, Q. et al. Diagnostic value of contrast-enhanced ultrasound for sentinel lymph node metastasis in breast cancer: an updated meta-analysis. Breast Cancer Res Treat 202, 221–231 (2023). https://doi.org/10.1007/s10549-023-07063-2

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