Diagnosis Of Sentinel Lymph Node Metastasis Ia Breast Cancer By Needle Biopsy Under Contrast-Enhanced Ultrasound:A Meta-Analysis

Objective: To evaluate the diagnostic value of needle biopsy of sentinel lymph nodes metastasis under the contrast-enhanced ultrasound for breast cancer patients by meta-analysis.Methods: Relevant studies published before December 9,2018 were identified through a comprehensive search of PubMed,Embase,Cochrane Library,Chinese National Knowledge Infrastructure,Wanfang Database,and VIP Database.The articles was screened according to the inclusion criteria and exclusion criteria.QUADAS-2 was used to evaluate the quality of articles in Review Manager 5.3 software.The pooled sensitivity(SEN),specificity(SPE),positive likelihood ratio(+LR),negative likelihood ratio(-LR),and diagnostic odds ratio(DOR)were calculated in the Meta-disc 1.4 software and the summary receiver operating characteristic(SROC)curve and area under the curve of ROC(AUC)were plotted.Deeks funnel plots were used to detect publication bias.Results: A total of 9 studies(1221 patients)included.The overall quality of the articles is medium,the risk of bias is acceptable,and the clinical applicability is good.The pooled SEN and SPE were 0.63(95%confidence interval [CI]: 0.57-0.68)and 1.00(95%CI: 0.99-1.00),respectively.The pooled +LR was 86.31(95%CI: 37.20-200.29).The pooled-LR was 0.35(95%CI: 0.25-0.49).The pooled DOR was 249.52(95%CI: 99.25-627.29).The AUC was 0.9774(SE=0.0084).Subgroup analysis:(1).The pooled SEN,SPE,+LR,-LR,DOR,and AUC of the conventional ultrasound-negative patients in the ipsilateral axilla were0.58,1.00,130.50,0.41,287.59,and 0.9793,respectively.The patients without preoperative ultrasound screening were 0.77,1.00,38.13,0.27,166.12,and 0.9750,respectively.(2).The pooled SEN,SPE,+LR,-LR,DOR,and AUC of the thick needle aspiration were 0.56,1.00,191.61,0.44,476.85,and 0.9856,respectively,and the fine needle aspirations were 0.79,1.00,56.90,0.22,262.97,and 0.9822,respectively.The Deeks funnel plot shows that the studies were asymmetric on both sides of the line with a slope of-2.88(P = 0.024).Conclusions: 1.For patients with negative conventional axillary ultrasound examination,needle biopsy under contrast-enhanced ultrasound mode can improve the preoperative detection of metastatic lymph nodes,but the sensitivity is lower than that of patients without preoperative conventional ultrasound screening.2.Patients with positiveresults of needle biopsy can perform axillary lymph node dissection directly,while patients with negative results still need to perform surgical sentinel lymph node biopsy.