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Prediction of sentinel lymph node status in patients with early breast cancer using breast imaging as an alternative to surgical staging-a systematic review and meta-analysis

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Title: Prediction of sentinel lymph node status in patients with early breast cancer using breast imaging as an alternative to surgical staging-a systematic review and meta-analysis
Authors: Rejmer, Cornelia, Hjärtström, Malin, Bendahl, Pär-Ola, Dihge, Looket, Skarping, Ida, Zhang, Daqu, Dustler, Magnus, Rydén, Lisa
Contributors: Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section I, Breast cancer treatment, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion I, Bröstcancerbehandling, Originator, Lund University, Profile areas and other strong research environments, Other Strong Research Environments, LUCC: Lund University Cancer Centre, Lunds universitet, Profilområden och andra starka forskningsmiljöer, Övriga starka forskningsmiljöer, LUCC: Lunds universitets cancercentrum, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section V, Surgery (Lund), Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion V, Kirurgi, Lund, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section II, Anesthesiology and Intensive Care, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion II, Anestesiologi och intensivvård, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section I, Breast cancer treatment, The Liquid Biopsy and Tumor Progression in Breast Cancer, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion I, Bröstcancerbehandling, The Liquid Biopsy och Tumörprogression i Bröstcancer, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section I, Breast cancer treatment, Personalized Breast Cancer Treatment, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion I, Bröstcancerbehandling, Individuell Bröstcancerbehandling, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Malmö, Surgery, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Malmö, Kirurgi, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section V, Surgery (Lund), Breast Cancer Surgery, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion V, Kirurgi, Lund, Bröstcancerkirurgi, Originator, Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Section I, Breastcancer, Breast cancer prevention & intervention, Lunds universitet, Medicinska fakulteten, Institutionen för kliniska vetenskaper, Lund, Sektion I, Bröstcancer, Bröstcancer - prevention & intervention, Originator, Lund University, Faculty of Science, Centre for Environmental and Climate Science (CEC), Computational Science for Health and Environment, Lunds universitet, Naturvetenskapliga fakulteten, Centrum för miljö- och klimatvetenskap (CEC), Beräkningsvetenskap för hälsa och miljö, Originator, Lund University, Faculty of Science, Centre for Environmental and Climate Science (CEC), Lunds universitet, Naturvetenskapliga fakulteten, Centrum för miljö- och klimatvetenskap (CEC), Originator, Lund University, Faculty of Medicine, Department of Translational Medicine, Radiology Diagnostics, Malmö, Lunds universitet, Medicinska fakulteten, Institutionen för translationell medicin, Diagnostisk radiologi, Malmö, Originator, Lund University, Faculty of Medicine, Department of Translational Medicine, Medical Radiation Physics, Malmö, Lunds universitet, Medicinska fakulteten, Institutionen för translationell medicin, Medicinsk strålningsfysik, Malmö, Originator
Source: Systematic Reviews.
Subject Terms: Medical and Health Sciences, Clinical Medicine, Cancer and Oncology, Medicin och hälsovetenskap, Klinisk medicin, Cancer och onkologi, Radiology and Medical Imaging, Radiologi och bildbehandling
Description: BACKGROUND: Prediction models for sentinel lymph node (SLN) status could potentially substitute surgical axillary staging in patients with early breast cancer. Several imaging modalities have been used with various feature extraction and selection approaches. This systematic review and meta-analysis aimed to evaluate prediction models for SLN status based on breast imaging in patients with early breast cancer to summarize the current evidence and to identify areas requiring additional research. METHODS: The systematic literature search strategy was based on the Population, Intervention, Comparison, and Outcome (PICO) framework: P: female patients with clinically node-negative invasive breast cancer scheduled to undergo primary surgery; I: breast imaging; C: upfront sentinel lymph node biopsy; and O: prediction model performance regarding SLN status. The search was conducted in the PubMed, Embase, Web of Science, Cochrane, and Cumulative Index to Nursing and Allied Health Literature databases in March 2024. The screening of records, data collection, and bias assessments were performed independently by two reviewers. The risk of bias was assessed via the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and the Prediction Model Study Risk of Bias Assessment Tool. A meta-analysis was performed using the random-effects model to assess performance and heterogeneity overall and in subgroups. RESULTS: The literature search resulted in the inclusion of 32 articles with 11,464 patients in total. Five imaging categories were included: ultrasound (n = 8), magnetic resonance imaging (MRI) (n = 17), mammography (n = 1), positron emission tomography computed tomography (n = 1), and multiple modalities (n = 5). Four studies, assessed as having a high risk of bias, were excluded from the meta-analysis. The meta-analysis revealed heterogeneity in overall performance, except for MRI-based studies, with a pooled area under the curve of 0.85 (95% confidence interval 0.82-0.87). Meta-regression indicated that MRI and model calibration assessment upon validation contributed to heterogeneity. CONCLUSIONS: This systematic review and meta-analysis revealed that prediction models using breast imaging-particularly MRI-could serve as a noninvasive alternative to surgical axillary staging in patients with early breast cancer. The results illustrate the heterogeneity between studies and the need for additional high-quality studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022301852, available at https://www.crd.york.ac.uk/PROSPERO.
Access URL: https://doi.org/10.1186/s13643-025-03005-9
Database: SwePub
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