Accuracy for cytological evaluation in the detection of breast cancer among patients with pathologic nipple discharge: a PRISMA-compliant meta-analysis.
Journal
Chinese medical journal
ISSN: 2542-5641
Titre abrégé: Chin Med J (Engl)
Pays: China
ID NLM: 7513795
Informations de publication
Date de publication:
20 Feb 2020
20 Feb 2020
Historique:
pubmed:
25
1
2020
medline:
15
12
2020
entrez:
25
1
2020
Statut:
ppublish
Résumé
Nipple discharge cytology is a simple non-invasive method that may provide valuable information for detecting underlying malignancy. Several studies have investigated the diagnostic value of cytology in breast cancer patients with pathological nipple discharge, but the results have been highly variable. Herein we presented a systematic review and meta-analysis of published studies pertaining to the diagnostic capacity of nipple discharge cytology in patients with breast cancer. A systematic literature search was performed (Medline/PubMed, Embase, Cochrane Library databases, and Google Scholar) to identify studies that investigated the diagnostic capacity of cytology with regard to breast cancer in patients with pathologic nipple discharge. Two independent researchers identified articles that assessed the sensitivity and specificity of cytological evaluation for breast cancer detection in patients with pathologic nipple discharge published between January 2000 and October 2018. Articles were only included in the meta-analysis if they met predetermined criteria. The characteristics of each study and the data they yielded were summarized. Quality assessment of all articles included was performed using the Methodological Index for Non-randomized Studies Criteria (MINORS) and the Quality Assessment of Diagnostic Accuracy Study 2 (QUADAS-2). Heterogeneity was tested via Cochran Q test and the I statistic using Stata 12.0 and Meta-DiSc 1.4 software, and meta-analysis was performed. A total of 286 articles were identified, of which 12 articles including a total of 1476 patients were deemed eligible for inclusion in the meta-analysis. A random-effects model assessing the capacity of nipple discharge cytology to predict breast cancer yielded pooled sensitivity 63% (95% confidence interval [CI]: 53%-72%), specificity 95% (95% CI: 87%-98%), positive likelihood ratio 12.35 (95% CI: 4.87-31.34), and negative likelihood ratio 0.39 (95% CI: 0.30-0.50). The diagnostic odds ratio was 31.88 (95% CI: 11.30-89.98). The area under the summary receiver operating characteristic curve was 0.79 (95% CI: 0.75-0.82). The current meta-analysis suggests that nipple discharge cytology is a useful diagnostic modality for detection of breast cancer in patients with pathological nipple discharge, with moderate sensitivity and high specificity.
Sections du résumé
BACKGROUND
BACKGROUND
Nipple discharge cytology is a simple non-invasive method that may provide valuable information for detecting underlying malignancy. Several studies have investigated the diagnostic value of cytology in breast cancer patients with pathological nipple discharge, but the results have been highly variable. Herein we presented a systematic review and meta-analysis of published studies pertaining to the diagnostic capacity of nipple discharge cytology in patients with breast cancer.
METHODS
METHODS
A systematic literature search was performed (Medline/PubMed, Embase, Cochrane Library databases, and Google Scholar) to identify studies that investigated the diagnostic capacity of cytology with regard to breast cancer in patients with pathologic nipple discharge. Two independent researchers identified articles that assessed the sensitivity and specificity of cytological evaluation for breast cancer detection in patients with pathologic nipple discharge published between January 2000 and October 2018. Articles were only included in the meta-analysis if they met predetermined criteria. The characteristics of each study and the data they yielded were summarized. Quality assessment of all articles included was performed using the Methodological Index for Non-randomized Studies Criteria (MINORS) and the Quality Assessment of Diagnostic Accuracy Study 2 (QUADAS-2). Heterogeneity was tested via Cochran Q test and the I statistic using Stata 12.0 and Meta-DiSc 1.4 software, and meta-analysis was performed.
RESULTS
RESULTS
A total of 286 articles were identified, of which 12 articles including a total of 1476 patients were deemed eligible for inclusion in the meta-analysis. A random-effects model assessing the capacity of nipple discharge cytology to predict breast cancer yielded pooled sensitivity 63% (95% confidence interval [CI]: 53%-72%), specificity 95% (95% CI: 87%-98%), positive likelihood ratio 12.35 (95% CI: 4.87-31.34), and negative likelihood ratio 0.39 (95% CI: 0.30-0.50). The diagnostic odds ratio was 31.88 (95% CI: 11.30-89.98). The area under the summary receiver operating characteristic curve was 0.79 (95% CI: 0.75-0.82).
CONCLUSION
CONCLUSIONS
The current meta-analysis suggests that nipple discharge cytology is a useful diagnostic modality for detection of breast cancer in patients with pathological nipple discharge, with moderate sensitivity and high specificity.
Identifiants
pubmed: 31977561
doi: 10.1097/CM9.0000000000000643
pmc: PMC7046245
pii: 00029330-202002200-00009
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
435-443Références
Chen L, Zhou WB, Zhao Y, Liu XA, Ding Q, Zha XM, et al. Bloody nipple discharge is a predictor of breast cancer risk: a meta-analysis. Breast Cancer Res Treat 2012; 132:9–14. doi: 10.1007/s10549-011-1787-5.
doi: 10.1007/s10549-011-1787-5
Dolan RT, Butler JS, Kell MR, Gorey TF, Stokes MA. Nipple discharge and the efficacy of duct cytology in evaluating breast cancer risk. Surgeon 2010; 8:252–258. doi: 10.1016/j.surge.2010.03.005.
doi: 10.1016/j.surge.2010.03.005
Lippa N, Hurtevent-Labrot G, Ferron S, Boisserie-Lacroix M. Nipple discharge: the role of imaging. Diagn Interv Imaging 2015; 96:1017–1032. doi: 10.1016/j.diii.2015.07.004.
doi: 10.1016/j.diii.2015.07.004
Patel BK, Falcon S, Drukteinis J. Management of nipple discharge and the associated imaging findings. Am J Med 2015; 128:353–360. doi: 10.1016/j.amjmed.2014.09.031.
doi: 10.1016/j.amjmed.2014.09.031
van Gelder L, Bisschops RH, Menke-Pluymers MB, Westenend PJ, Plaisier PW. Magnetic resonance imaging in patients with unilateral bloody nipple discharge; useful when conventional diagnostics are negative? World J Surg 2015; 39:184–186. doi: 10.1007/s00268-014-2701-1.
doi: 10.1007/s00268-014-2701-1
Wang LJ, Wu P, Li XX, Luo R, Wang DB, Guan WB. Magnetic resonance imaging features for differentiating breast papilloma with high-risk or malignant lesions from benign papilloma: a retrospective study on 158 patients. World J Surg Oncol 2018; 16:234doi: 10.1186/s12957-018-1537-9.
doi: 10.1186/s12957-018-1537-9
Morrogh M, Morris EA, Liberman L, Borgen PI, King TA. The predictive value of ductography and magnetic resonance imaging in the management of nipple discharge. Ann Surg Oncol 2007; 14:3369–3377. doi: 10.1245/s10434-007-9530-5.
doi: 10.1245/s10434-007-9530-5
Feng XZ, Song YH, Zhang FX, Jiang CW, Mei H, Zhao B. Diagnostic accuracy of fiberoptic ductoscopy plus in vivo iodine staining for intraductal proliferative lesions. Chin Med J 2013; 126:3124–3129. doi: 10.3760/cma.j.issn.0366-6999.20130691.
doi: 10.3760/cma.j.issn.0366-6999.20130691
Wang C, Luan S, Panayi AC, Xin MQ, Luan J. Methods used for evaluation of volume retention rate in autologous fat grafting for breast augmentation: a systematic review. Chin Med J 2019; 132:2223–2228. doi: 10.1097/CM9.0000000000000415.
doi: 10.1097/cm9.0000000000000415
Zamora J, Abraira V, Muriel A, Khan K, Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 2006; 6:31doi: 10.1186/1471-2288-6-31.
doi: 10.1186/1471-2288-6-31
Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 2009; 374:609–619. doi: 10.1016/s0140-6736(09)60879-5.
doi: 10.1016/s0140-6736(09)60879-5
Dinnes J, Deeks J, Kirby J, Roderick P. A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy. Health Technol Assess 2005; 9:1–113. doi: 10.3310/hta9120.
doi: 10.3310/hta9120
Kan WM, Chen C, Kwong A. Implications of nipple discharge in Hong Kong Chinese women. Hong Kong Med J 2018; 24:18–24. doi: 10.12809/hkmj154764.
doi: 10.12809/hkmj154764
Pan CX, Yang JH, Zou LM, Wu YY, Zhang XR, Mi XJ. The clinical value of nipple discharge diagnosis by fiberoptic ductoscopy system combined with thinprep cytology test (in Chinese). Guangdong Med J 2014; 35:2054–2056. doi: 10.3969/j.issn.1001-9448.2014.13.027.
doi: 10.3969/j.issn.1001-9448.2014.13.027
Lian ZQ, Zhang JY, Wang Q, Zhang AQ, Zhu CX, Wu L. Evaluation of fiberoptic ductoscopy system and thinprep cytology test in diagnosis of pathological nipple discharge (in Chinese). Chin J Cancer Prev Treat 2012; 19:770–773.
Zhang AQ, Wang Q, Zhang JY, et al. Intraductal aspiration TCT by Fiberoptic ductoscopy for patients with nipple discharge (in Chinese). Chin J Breast Dis (electronic version) 2007; 1:19–21. doi: 10.3969/j.issn.1674-0807.2007.02.006.
doi: 10.3969/j.issn.1674-0807.2007.02.006
Pritt B, Pang Y, Kellogg M, St John T, Elhosseiny A. Diagnostic value of nipple cytology: study of 466 cases. Cancer 2004; 102:233–238. doi: 10.1002/cncr.20379.
doi: 10.1002/cncr.20379
Cabioglu N, Hunt KK, Singletary SE, Stephens TW, Marcy S, Meric F, et al. Surgical decision making and factors determining a diagnosis of breast carcinoma in women presenting with nipple discharge. J Am Coll Surg 2003; 196:354–364. doi: 10.1016/s1072-7515(02)01606-x.
doi: 10.1016/s1072-7515(02)01606-x
Baitchev G, Gortchev G, Todorova A, Dikov D, Stancheva N, Daskalova I. Intraductal aspiration cytology and galactography for nipple discharge. Int Surg 2003; 88:83–86. doi: 10.1177/106689690301100217.
doi: 10.1177/106689690301100217
Yamamoto D, Senzaki H, Nakagawa H, Okugawa H, Gondo H, Tanaka K. Detection of chromosomal aneusomy by fluorescence in situ hybridization for patients with nipple discharge. Cancer 2003; 97:690–694. doi: 10.1002/cncr.11091.
doi: 10.1002/cncr.11091
Shen KW, Wu J, Lu JS, Han QX, Shen ZZ, Nguyen M, et al. Fiberoptic ductoscopy for breast cancer patients with nipple discharge. Surg Endosc 2001; 15:1340–1345. doi: 10.1007/s004640080108.
doi: 10.1007/s004640080108
Lee WY. Cytology of abnormal nipple discharge: a cyto-histological correlation. Cytopathology 2003; 14:19–26. doi: 10.1046/j.1365-2303.2003.00419.x.
doi: 10.1046/j.1365-2303.2003.00419.x
Yamamoto D, Shoji T, Kawanishi H, Nakagawa H, Haijima H, Gondo H, et al. A utility of ductography and fiberoptic ductoscopy for patients with nipple discharge. Breast Cancer Res Treat 2001; 70:103–108. doi: 10.1023/a:1012990809466.
doi: 10.1023/a:1012990809466
Hou M, Tsai K, Lin H, Chai C, Liu C, Huang T. A simple intraductal aspiration method for cytodiagnosis in nipple discharge. Acta Cytol 2000; 44:1029–1034. doi: 10.1159/000328592.
doi: 10.1159/000328592
Istomin A, Masarwah A, Pitkanen M, Joukainen S, Sutela A, Vanninen R, et al. Galactography is not an obsolete investigation in the evaluation of pathological nipple discharge. PLoS One 2018; 13:e0204326doi: 10.1371/journal.pone.0204326.
doi: 10.1371/journal.pone.0204326
Liu GY, Lu JS, Shen KW, Wu J, Chen CM, Hu Z, et al. Fiberoptic ductoscopy combined with cytology testing in the patients of spontaneous nipple discharge. Breast Cancer Res Treat 2008; 108:271–277. doi: 10.1007/s10549-007-9598-4.
doi: 10.1007/s10549-007-9598-4
Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 2003; 56:1129–1135. doi: 10.1016/S0895-4356(03)00177-X.
doi: 10.1016/s0895-4356(03)00177-x
Kamali S, Bender O, Kamali GH, Aydin MT, Karatepe O, Yuney E. Diagnostic and therapeutic value of ductoscopy in nipple discharge and intraductal proliferations compared with standard methods. Breast Cancer 2014; 21:154–161. doi: 10.1007/s12282-012-0377-7.
doi: 10.1007/s12282-012-0377-7
Denewer A, El-Etribi K, Nada N, El-Metwally M. The role and limitations of mammary ductoscope in management of pathologic nipple discharge. Breast J 2008; 14:442–449. doi: 10.1111/j.1524-4741.2008.00620.x.
doi: 10.1111/j.1524-4741.2008.00620.x
Masukawa T. Discovery of psammoma bodies and fungus organisms in the nipple secretion with improved breast cytology technique. Acta Cytol 1972; 16:408–415.