Value of circulating cell-free DNA analysis as a diagnostic tool for breast cancer: a meta-analysis
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Ziqiang Lin1,*, James Neiswender2,*, Bin Fang1,3,*, Xuelei Ma1, Jing Zhang1, Xiuying Hu1,4
1State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, China
2Program in Molecular Medicine, Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA
3Sixth Unit of Internal Medicine, Dujiangyan Medical Center, Dujiangyan, Sichuan 611830, China
4Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
*These authors contributed equally to this work
Xiuying Hu, email: [email protected]
Keywords: cell-free DNA, breast cancer, diagnosis, meta-analysis, accuracy
Received: October 07, 2016 Accepted: February 15, 2017 Published: February 28, 2017
Objectives: The aim of this study was to systematically evaluate the diagnostic value of cell free DNA (cfDNA) for breast cancer.
Results: Among 308 candidate articles, 25 with relevant diagnostic screening qualified for final analysis. The mean sensitivity, specificity and area under the curve (AUC) of SROC plots for 24 studies that distinguished breast cancer patients from healthy controls were 0.70, 0.87, and 0.9314, yielding a DOR of 32.31. When analyzed in subgroups, the 14 quantitative studies produced sensitivity, specificity, AUC, and a DOR of 0.78, 0.83, 0.9116, and 24.40. The 10 qualitative studies produced 0.50, 0.98, 0.9919, and 68.45. For 8 studies that distinguished malignant breast cancer from benign diseases, the specificity, sensitivity, AUC and DOR were 0.75, 0.79, 0.8213, and 9.49. No covariate factors had a significant correlation with relative DOR. Deek’s funnel plots indicated an absence of publication bias.
Materials and Methods: Databases were searched for studies involving the use of cfDNA to diagnose breast cancer. The studies were analyzed to determine sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio (DOR), and the summary receiver operating characteristic (SROC). Covariates were evaluated for effect on relative DOR. Deek’s Funnel plots were generated to measure publication bias.
Conclusions: Our analysis suggests a promising diagnostic potential of using cfDNA for breast cancer screening, but this diagnostic method is not yet independently sufficient. Further work refining qualitative cfDNA assays will improve the correct diagnosis of breast cancers.
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