Diagnostic value of seven biomarkers for breast cancer: an overview with evidence mapping and indirect comparisons of diagnostic test accuracy

Liquid biopsy biomarkers in breast cancer: An overview of systematic reviews

Breast cancer (BC) is the leading type of cancer affecting women globally and remains a significant cause of death. The diagnostic accuracy of liquid biopsy (LB) in the diagnosis of BC has not been well established. This overview synthesizes and critically evaluates the diagnostic test accuracy (DTA) of LB biomarkers in individuals with BC. Of 433 systematic reviews, eleven were included, assessing Fourier transform infrared (FTIR) spectroscopy, circulating tumor cells (CTCs), cell-free DNA (cfDNA), and microRNAs (miRNAs). The overall methodological quality of most of the reviews included was rated as critically low (n = 9, 81.8 %), and the remaining reviews were ranked as low and moderate. Key findings include CTCs with moderate sensitivity (0.50, 95 % confidence interval (CI) 0.48-0.52) and high specificity (0.93, 95 % CI: 0.92-0.95) with moderate certainty; cfDNA assays with high sensitivity (0.71-0.86) and specificity (0.88) with high certainty; FTIR assays with high sensitivity (0.97, 95 % CI: 0.94-0.96) and specificity (0.92, 95 % CI: 0.88-0.95) but low certainty. The miRNAs showed moderate to high sensitivity, while miR-21 had high specificity. Our overview indicates that identified liquid biopsies could serve as valuable tools for the diagnosis of breast cancer.

EBCC-13 manifesto: Balancing pros and cons for contralateral prophylactic mastectomy

After a diagnosis of unilateral breast cancer, increasing numbers of patients are requesting contralateral prophylactic mastectomy (CPM), the surgical removal of the healthy breast after diagnosis of unilateral breast cancer. It is important for the community of breast cancer specialists to provide meaningful guidance to women considering CPM. This manifesto discusses the issues and challenges of CPM and provides recommendations to improve oncological, surgical, physical and psychological outcomes for women presenting with unilateral breast cancer: (1) Communicate best available risks in manageable timeframes to prioritise actions; better risk stratification and implementation of risk-assessment tools combining family history, genetic and genomic information, and treatment and prognosis of the first breast cancer are required; (2) Reserve CPM for specific situations; in women not at high risk of contralateral breast cancer (CBC), ipsilateral breast-conserving surgery is the recommended option; (3) Encourage patients at low or intermediate risk of CBC to delay decisions on CPM until treatment for the primary cancer is complete, to focus on treating the existing disease first; (4) Provide patients with personalised information about the risk:benefit balance of CPM in manageable timeframes; (5) Ensure patients have an informed understanding of the competing risks for CBC and that there is a realistic plan for the patient; (6) Ensure patients understand the short- and long-term physical effects of CPM; (7) In patients considering CPM, offer psychological and surgical counselling before surgery; anxiety alone is not an indication for CPM; (8) Eliminate inequality between countries in reimbursement strategies; CPM should be reimbursed if it is considered a reasonable option resulting from multidisciplinary tumour board assessment; (9) Treat breast cancer patients at specialist breast units providing the entire patient-centred pathway.

Relationship between diagnostic accuracy of microRNAs for NSCLC and number of combined microRNAs: an overview with meta-analysis

Objective: Several systematic reviews (SRs) have assessed the diagnostic accuracy of microRNAs (miRNAs) for NSCLC, and this overview aimed to assess the relationship between diagnostic accuracy of miRNAs for NSCLC and number of microRNAs combinations. Methods: Embase.com, PubMed, the Cochrane Library, and Web of Science were searched. The PRISMA-DTA was used for reporting quality evaluation. Meta-analysis was conducted to assess the pooled diagnostic accuracy of different miRNAs combinations, and subgroup analyses were performed based on the source of miRNA. Results: Fourteen SRs with 91 original studies were included. Three SRs had minimal reporting flaws, and 11 SRs had medium flaws. The pooled sensitivity and specificity were 0.76 and 0.80 for single miRNA, 0.80 and 0.81 for two miRNAs combined, 0.82 and 0.88 for three miRNAs combined, 0.88 and 0.92 for four miRNAs combined, 0.87 and 0.87 for five miRNAs combined, and 0.87 and 0.89 for six or more miRNAs combined. And miR-21 was mostly appeared. Subgroup analyses suggested that the serum-derived miRNA had the relatively best diagnostic value compared to other sources. Conclusions: Future studies should explore specific and serum-derived miRNAs in NSCLC and combine them to improve the diagnosis accuracy of NSCLC, which had great significance in economic efficiency.

The value of different imaging methods in the diagnosis of breast cancer: A protocol for network meta-analysis of diagnostic test accuracy

BACKGROUND

: Breast cancer (BC) is the most common cancer in women all over the world and the second most common cause of cancer-related mortality. Imaging examination plays an important role in the diagnosis of early breast cancer. Due to different imaging principles and methods, all kinds of examinations have their advantages and disadvantages. It is particularly important for clinicians to choose these examination methods reasonably to achieve the best diagnostic effect. The objectives of this systematic review and NMA are to determine the diagnostic accuracy of imaging technologies for breast cancer and to compare the diagnostic accuracy of different index tests and to support guidelines development and clinical practice.

METHODS

: PubMed, Embase.com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be searched to identify relevant studies up to August 31, 2021. We will include random controlled trials, cross-sectional studies, case-control studies, and cohort studies that evaluate the diagnostic accuracy of different imaging diagnostic methods for breast cancer. The Quality Assessment of Diagnostic Accuracy Studies 2 quality assessment tool will be used to assess the risk of bias in each study. Standard pairwise meta-analysis and NMA will be performed using STATA V.12.0, MetaDiSc 1.40, and R 3.4.1 software to compare the diagnostic efficacy of different imaging diagnostic methods. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity.

RESULTS

: The results of this study will be published in a peer-reviewed journal.

CONCLUSION

: This study will comprehensively evaluate the accuracy of different imaging diagnostic methods in the diagnosis of breast cancer. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.

Machine Learning Models to Improve the Differentiation Between Benign and Malignant Breast Lesions on Ultrasound: A Multicenter External Validation Study

Purpose

This study aimed to establish and evaluate the usefulness of a simple, practical, and easy-to-promote machine learning model based on ultrasound imaging features for diagnosing breast cancer (BC).

Materials and Methods

Logistic regression, random forest, extra trees, support vector, multilayer perceptron, and XG Boost models were developed. The modeling data set of 1345 cases was from a tertiary class A hospital in China. The external validation data set of 1965 cases were from 3 tertiary class A hospitals and 2 primary hospitals. The area under the receiver operating characteristic curve (AUC) was used as the main evaluation index, and pathological biopsy was used as the gold standard for evaluating each model. Diagnostic capability was also compared with that of clinicians.

Results

Among the six models, the logistic model showed superior diagnostic efficiency, with an AUC of 0.771 and 0.906 and Brier scores of 0.181 and 0.165 in the test and validation sets, respectively. The AUCs of the clinician diagnosis and the logistic model were 0.913 and 0.906. Their AUCs in the tertiary class A hospitals were 0.915 and 0.915, respectively, and were 0.894 and 0.873 in primary hospitals, respectively.

Conclusion

The externally validated logical model can be used to distinguish between malignant and benign breast lesions in ultrasound images. Compared with clinician diagnosis, the logistic model has better diagnostic efficiency, making it potentially useful to assist in screening, particularly in lower level medical institutions.

Trial Registration

http://www.clinicaltrials.gov. ClinicalTrials.gov ID: NCT03080623.

Effect of Taijiquan assisted rehabilitation for breast cancer patients: A protocol for systematic review and meta-analysis

BACKGROUND

Taijiquan, as a supplementary and alternative method, has attracted more and more attention in the treatment of breast cancer. But up to now, no systematic review has been performed to evaluate the efficacy of Taijiquan in the treatment of breast cancer. In this study, Cochrane systematic review method will be used to evaluate the effect of Taijiquan in the rehabilitation process of breast cancer patients after treatment.

METHODS

PubMed, Embase. com, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and SinoMed will be searched to identify relevant studies up to May 31, 2021. We will include randomized controlled trials (RCTs) of the application of Taijiquan in post-treatment breast cancer patients. We will use the Cochrane bias risk assessment tool to assess the quality of included RCTs. We will use Stata 13.0 to perform pairwise meta-analyses using the inverse variance method. Subgroup analyses and sensitivity analyses will be conducted to investigate the sources of heterogeneity.

RESULTS

The results of this study will be published in a peer-reviewed journal.

CONCLUSION

This study will comprehensively evaluate the efficacy of Taijiquan in the rehabilitation treatment of breast cancer. The results of this study will provide high-quality evidence to support clinical practice and guidelines development.

Upregulated N6-Methyladenosine RNA in Peripheral Blood: Potential Diagnostic Biomarker for Breast Cancer

Purpose

An effective biomarker for the diagnosis of breast cancer (BC) and benign breast diseases (BBD) is crucial for improving the prognosis. We investigated whether N6-methyladenosine (m⁶A) can be a diagnostic biomarker of BC.

Materials and Methods

We detected the contents of peripheral blood m⁶A in 62 patients with BC, 41 patients with BBD, and 41 normal controls (NCs) using the colorimetric method. The relative expression of the m⁶A regulated genes methyltransferase-like 14 (METTL14) and fat mass and obesity-associated (FTO) was analyzed using quantitative real-time polymerase chain reaction.

Results

m⁶A in peripheral blood RNA was significantly higher in patients with BC than that in patients with BBD (p < 0.001) or the NCs (p < 0.001). m⁶A was closely associated with the disease stage (from stage 0 to stage I-IV, p=0.003). The receiver operating characteristic curve of m⁶A contained an area under the curve (AUC) value of 0.887 in BC, which was greater than that of carcinoembryonic antigen (CEA) or carbohydrate antigen 153 (CA153). The combination of m⁶A, CEA, and CA153 improved the AUC to 0.914. The upregulated and downregulated mRNA expression of METTL14 and FTO, respectively, might contribute to the increase of m⁶A in patients with BC. m⁶A combined with METTL14 and FTO improved the AUC to 0.929 with a specificity of 97.4% in the peripheral blood of patients with BC.

Conclusion

The peripheral blood RNA of m⁶A might be a valuable biomarker for the diagnosis of BC.