BACKGROUND Several studies have reported the prognostic value of ultrasound elastography(UE)in patients receiving neoadjuvant chemotherapy(NACT)for breast cancer.However,the assessment of parameters differed between s...BACKGROUND Several studies have reported the prognostic value of ultrasound elastography(UE)in patients receiving neoadjuvant chemotherapy(NACT)for breast cancer.However,the assessment of parameters differed between shear-wave elastography and strain elastography in terms of measured elasticity parameter and mode of imaging.It is important,therefore,to assess the accuracy of the two modes of elastography.AIM To assess the accuracy of UE for predicting the pathologic complete response(pCR)in breast cancer patients following NACT.METHODS A comprehensive and systematic search was performed in the databases of MEDLINE,EMBASE,SCOPUS,PubMed Central,CINAHL,Web of Science and Cochrane library from inception until December 2020.Meta-analysis was performed using STATA software“Midas”package.RESULTS A total of 14 studies with 989 patients were included.The pooled sensitivities were 86%[95%confidence interval(CI):76%-92%]for UE,77%(95%CI:68%-84%)for shear-wave elasto-graphy,and 92%(95%CI:73%-98%)for strain-wave elastography.The pooled score specificities were 86%(95%CI:80%-90%)for UE,84%(95%CI:72%-91%)for shear-wave elasticity,and 87%(95%CI:81%-92%)for strain-wave elastography.A significant heterogeneity was found among studies based on the chi-square test results and an I2 statistic>75%.CONCLUSION Strain-wave type of UE can accurately predict the pCR following NACT amongst breast cancer patients.Studies exploring its accuracy in different ethnic populations are required to strengthen the evidence.展开更多
Purpose： To determine the diagnostic performance of 3＇-deoxy-3＇-18F-fluorothymidine positron emission tomography/computed tomography（FLT PET/CT） and FLT PET for evaluating response to chemotherapy in patients wit...Purpose： To determine the diagnostic performance of 3＇-deoxy-3＇-18F-fluorothymidine positron emission tomography/computed tomography（FLT PET/CT） and FLT PET for evaluating response to chemotherapy in patients with breast cancer.Methods： Databases such as Pub Med（MEDLINE included） and excerpta medica database（EMBASE）, were searched for relevant original articles. The included studies were assessed for methodological quality with quality assessment of diagnosis accuracy studies（QUADAS） score tool. Histopathological analysis and/or clinical and/or radiological follow-up for at least 6 months were used as the reference standard. The data were extracted by two reviewers independently to analyze the sensitivity, specificity, summary receiver operating characteristic（SROC） curve, area under the curve（AUC）, and heterogeneity.Results： The present study analyzed a total of 4 selected articles. The pool sensitivity was 0.773 [95% confidence interval（CI）： 0.594-0.900]. The pooled specificity was 0.685（95% CI： 0.479-0.849） on basis of FEM. The pooled LR^＋, LR^-, and DOR were 2.874（1.492-5.538）, 0.293（0.146-0.589）, and 14.891（3.238-68.475）, respectively. The AUC was 0.8636（±0.0655）, and the Q＊ index was 0.7942（±0.0636）.Conclusions： Our results indicate that 18^F-FLT PET/CT or PET is useful to predict chemotherapy response in breast cancer with reasonable sensitivity, specificity and DOR. However, future larger scale clinical trials will be needed to assess the regimen of 18^F-FLT PET/CT or PET in monitoring the response to chemotherapy in breast cancer patients.展开更多
Objective： To evaluate the available evidence from randomized controlled trials （RCTs） of auricular acupressure （AA） therapy for preventing constipation in breast cancer patients undergoing chemotherapy. Methods...Objective： To evaluate the available evidence from randomized controlled trials （RCTs） of auricular acupressure （AA） therapy for preventing constipation in breast cancer patients undergoing chemotherapy. Methods： The following databases were searched from their inception until August 2017： Ovid Medline, Embase, the Cochrane Central Register of Controlled Trials （CENTRAL）, and Allied and Alternative Medieine （AMED）. We also searched four Chinese databases： Chinese BioMedical Database （CBM）, China National Knowledge Infrastructure （CNKI）, WANFANG Data, and Chinese VIP Database. Only the RCTs related to the effects of AA therapy on preventing constipation in breast cancer patients undergoing chemotherapy were included in this study. Quantitative syntheses of data from RCTs were conducted using RevMan 5.3 software. Study selection, data extraction, and validation were performed independently by two authors. Cochrane criteria for risk of bias were used to assess the methodological quality of the trials. Results： Four RCTs met the inclusion criteria, and most were of low methodological quality. Study participants in the AA plus routine care group showed significantly greater improvements in the response rate （risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.14, 1.42], P 〈 0.01） with low heterogeneity （x2=2.31, P =0.31, F = 14%）. In addition, when compared with routine care alone, one RCT suggested favorable statistically significant effects of AA plus routine care on Constipation Assessment Scale （CAS; mean difference [MD] =-5.07, 95% CI [-6.86, -3.28], P 〈 0.01）. Furthermore, when compared with routine care alone, one RCT suggested positive statistically significant effects of AA plus routine care on Patient Assessment of Constipation-Quality of Life （PAC-QOL; MD = -1.26, 95% CI [-1.59, -0.93], P 〈 0.01）. Conclusions： Overall, as a potential safety therapy, only weak evidence can support the hypothesis that AA can effectively prevent constipation in breast cancer patients undergoing chemotherapy.展开更多
Purpose: To evaluate the accuracy and the predictive value of 18F-FDG PET or PET/CT in the assessment of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer by meta-analysis. Materials and Methods: Releva...Purpose: To evaluate the accuracy and the predictive value of 18F-FDG PET or PET/CT in the assessment of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer by meta-analysis. Materials and Methods: Relevant studies were identified by systematic searches of PUBMED and COCHRANE databases, published in English. To ensure homogeneity of all included studies, selection criteria were established and all the studies were scored according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. Meta-analysis was done on the diagnostic performance data from eligible studies. Draw funnel plots to explore the publication bias. Draw forest plots to exclude abnormal data(s). Use Spearman correlation coefficients p, likelihood ratio x2 test and I2 index in order to indicate heterogeneity. Estimate and compare the weighted summary sensitivities (SEs), specificities (SPs), diagnostic odds ratios (DORs), and summary receiver operating characteristic (SROC) curves of PET and other examinations (measuring the size of tumor). Subgroup analyses were performed to identify heterogeneity potential sources. Do Z test to find significant difference between each results. Results: 27 groups of data in 19 eligible studies were included with a total of 1164 subjects evaluated by 18F-FDG PET or PET/CT and 291 ones evaluated by other examinations. Funnel plots showed the existence of publication bias. Spearman correlation coefficients p, likelihood ratio x2 test and I2 index explored the heterogeneity. The Results of the Weighted Summary: SEPET was significantly higher than SED [83.7% (329/393) vs. 59.0% (98/166), p SPPET was significantly higher than SPD [66.8% (512/766) vs. 40.8% (51/125), p DORPET was significantly higher than DORD (14.02 vs. 1.29, p AUCPET and Q*PET were both significantly higher than AUCD and Q*D (AUCs 0.8838 vs. 0.6046;Q*s 0.8143 vs. 0.5788, p st or 2nd cycle of NAC was a litter better than later with higher SE (p = 0.083). Standardized uptake value (SUV) reduction rate between 40% and 45% as FDG-PET response threshold value was used for its highest SP (p = 0.01), while no significant difference was found comparing SEs and DORs (p > 0.05). Trend of higher SE and lower SP were found at ER negative breast cancers than ER positive ones (SEs 93.94% vs. 83.33%;SPs 35.76% vs. 62.24%), though Z test did not find significant difference (p > 0.05). Conclusion: This meta-analysis showed that FDG-PET or PET/CT does have a higher global accuracy in assessing the response for NAC in breast cancer. Comparing with clinical response, metabolic response plays a potential role in directing therapy for breast cancer. Factors which affected the accuracy of FDG-PET assessment included PET timing point, SUV reduction rate as threshold value and ER expression.展开更多
文摘BACKGROUND Several studies have reported the prognostic value of ultrasound elastography(UE)in patients receiving neoadjuvant chemotherapy(NACT)for breast cancer.However,the assessment of parameters differed between shear-wave elastography and strain elastography in terms of measured elasticity parameter and mode of imaging.It is important,therefore,to assess the accuracy of the two modes of elastography.AIM To assess the accuracy of UE for predicting the pathologic complete response(pCR)in breast cancer patients following NACT.METHODS A comprehensive and systematic search was performed in the databases of MEDLINE,EMBASE,SCOPUS,PubMed Central,CINAHL,Web of Science and Cochrane library from inception until December 2020.Meta-analysis was performed using STATA software“Midas”package.RESULTS A total of 14 studies with 989 patients were included.The pooled sensitivities were 86%[95%confidence interval(CI):76%-92%]for UE,77%(95%CI:68%-84%)for shear-wave elasto-graphy,and 92%(95%CI:73%-98%)for strain-wave elastography.The pooled score specificities were 86%(95%CI:80%-90%)for UE,84%(95%CI:72%-91%)for shear-wave elasticity,and 87%(95%CI:81%-92%)for strain-wave elastography.A significant heterogeneity was found among studies based on the chi-square test results and an I2 statistic>75%.CONCLUSION Strain-wave type of UE can accurately predict the pCR following NACT amongst breast cancer patients.Studies exploring its accuracy in different ethnic populations are required to strengthen the evidence.
基金supported by the Open Program of Key Laboratory of Nuclear Medicine, Ministry of Health and Jiangsu Key Laboratory of Molecular Nuclear Medicine (KF201305 and KF201306)Science and Technology Development Program of Suzhou (SYSD2013076)
文摘Purpose： To determine the diagnostic performance of 3＇-deoxy-3＇-18F-fluorothymidine positron emission tomography/computed tomography（FLT PET/CT） and FLT PET for evaluating response to chemotherapy in patients with breast cancer.Methods： Databases such as Pub Med（MEDLINE included） and excerpta medica database（EMBASE）, were searched for relevant original articles. The included studies were assessed for methodological quality with quality assessment of diagnosis accuracy studies（QUADAS） score tool. Histopathological analysis and/or clinical and/or radiological follow-up for at least 6 months were used as the reference standard. The data were extracted by two reviewers independently to analyze the sensitivity, specificity, summary receiver operating characteristic（SROC） curve, area under the curve（AUC）, and heterogeneity.Results： The present study analyzed a total of 4 selected articles. The pool sensitivity was 0.773 [95% confidence interval（CI）： 0.594-0.900]. The pooled specificity was 0.685（95% CI： 0.479-0.849） on basis of FEM. The pooled LR^＋, LR^-, and DOR were 2.874（1.492-5.538）, 0.293（0.146-0.589）, and 14.891（3.238-68.475）, respectively. The AUC was 0.8636（±0.0655）, and the Q＊ index was 0.7942（±0.0636）.Conclusions： Our results indicate that 18^F-FLT PET/CT or PET is useful to predict chemotherapy response in breast cancer with reasonable sensitivity, specificity and DOR. However, future larger scale clinical trials will be needed to assess the regimen of 18^F-FLT PET/CT or PET in monitoring the response to chemotherapy in breast cancer patients.
文摘Objective： To evaluate the available evidence from randomized controlled trials （RCTs） of auricular acupressure （AA） therapy for preventing constipation in breast cancer patients undergoing chemotherapy. Methods： The following databases were searched from their inception until August 2017： Ovid Medline, Embase, the Cochrane Central Register of Controlled Trials （CENTRAL）, and Allied and Alternative Medieine （AMED）. We also searched four Chinese databases： Chinese BioMedical Database （CBM）, China National Knowledge Infrastructure （CNKI）, WANFANG Data, and Chinese VIP Database. Only the RCTs related to the effects of AA therapy on preventing constipation in breast cancer patients undergoing chemotherapy were included in this study. Quantitative syntheses of data from RCTs were conducted using RevMan 5.3 software. Study selection, data extraction, and validation were performed independently by two authors. Cochrane criteria for risk of bias were used to assess the methodological quality of the trials. Results： Four RCTs met the inclusion criteria, and most were of low methodological quality. Study participants in the AA plus routine care group showed significantly greater improvements in the response rate （risk ratio [RR] = 1.27, 95% confidence interval [CI] [1.14, 1.42], P 〈 0.01） with low heterogeneity （x2=2.31, P =0.31, F = 14%）. In addition, when compared with routine care alone, one RCT suggested favorable statistically significant effects of AA plus routine care on Constipation Assessment Scale （CAS; mean difference [MD] =-5.07, 95% CI [-6.86, -3.28], P 〈 0.01）. Furthermore, when compared with routine care alone, one RCT suggested positive statistically significant effects of AA plus routine care on Patient Assessment of Constipation-Quality of Life （PAC-QOL; MD = -1.26, 95% CI [-1.59, -0.93], P 〈 0.01）. Conclusions： Overall, as a potential safety therapy, only weak evidence can support the hypothesis that AA can effectively prevent constipation in breast cancer patients undergoing chemotherapy.
文摘Purpose: To evaluate the accuracy and the predictive value of 18F-FDG PET or PET/CT in the assessment of neoadjuvant chemotherapy (NAC) in locally advanced breast cancer by meta-analysis. Materials and Methods: Relevant studies were identified by systematic searches of PUBMED and COCHRANE databases, published in English. To ensure homogeneity of all included studies, selection criteria were established and all the studies were scored according to Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. Meta-analysis was done on the diagnostic performance data from eligible studies. Draw funnel plots to explore the publication bias. Draw forest plots to exclude abnormal data(s). Use Spearman correlation coefficients p, likelihood ratio x2 test and I2 index in order to indicate heterogeneity. Estimate and compare the weighted summary sensitivities (SEs), specificities (SPs), diagnostic odds ratios (DORs), and summary receiver operating characteristic (SROC) curves of PET and other examinations (measuring the size of tumor). Subgroup analyses were performed to identify heterogeneity potential sources. Do Z test to find significant difference between each results. Results: 27 groups of data in 19 eligible studies were included with a total of 1164 subjects evaluated by 18F-FDG PET or PET/CT and 291 ones evaluated by other examinations. Funnel plots showed the existence of publication bias. Spearman correlation coefficients p, likelihood ratio x2 test and I2 index explored the heterogeneity. The Results of the Weighted Summary: SEPET was significantly higher than SED [83.7% (329/393) vs. 59.0% (98/166), p SPPET was significantly higher than SPD [66.8% (512/766) vs. 40.8% (51/125), p DORPET was significantly higher than DORD (14.02 vs. 1.29, p AUCPET and Q*PET were both significantly higher than AUCD and Q*D (AUCs 0.8838 vs. 0.6046;Q*s 0.8143 vs. 0.5788, p st or 2nd cycle of NAC was a litter better than later with higher SE (p = 0.083). Standardized uptake value (SUV) reduction rate between 40% and 45% as FDG-PET response threshold value was used for its highest SP (p = 0.01), while no significant difference was found comparing SEs and DORs (p > 0.05). Trend of higher SE and lower SP were found at ER negative breast cancers than ER positive ones (SEs 93.94% vs. 83.33%;SPs 35.76% vs. 62.24%), though Z test did not find significant difference (p > 0.05). Conclusion: This meta-analysis showed that FDG-PET or PET/CT does have a higher global accuracy in assessing the response for NAC in breast cancer. Comparing with clinical response, metabolic response plays a potential role in directing therapy for breast cancer. Factors which affected the accuracy of FDG-PET assessment included PET timing point, SUV reduction rate as threshold value and ER expression.
