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Meta-Analysis
. 2021 Jul;28(7):3751-3760.
doi: 10.1245/s10434-020-09313-9. Epub 2020 Nov 9.

Diagnostic Accuracy of Nipple Aspirate Fluid Cytology in Asymptomatic Patients: A Meta-analysis and Systematic Review of the Literature

Natasha Jiwa  1 , Rishikesh Gandhewar  2 , Hemali Chauhan  2 , Hutan Ashrafian  2 , Swathica Kumar  3 , Corrina Wright  4 , Zoltan Takats  2 , Daniel Richard Leff  2
Affiliations
Meta-Analysis

Diagnostic Accuracy of Nipple Aspirate Fluid Cytology in Asymptomatic Patients: A Meta-analysis and Systematic Review of the Literature

Natasha Jiwa et al. Ann Surg Oncol. 2021 Jul.

Abstract

Purpose: To calculate the diagnostic accuracy of nipple aspirate fluid (NAF) cytology.

Background: Evaluation of NAF cytology in asymptomatic patients conceptually offers a non-invasive method for either screening for breast cancer or else predicting or stratifying future cancer risk.

Methods: Studies were identified by performing electronic searches up to August 2019. A meta-analysis was conducted to attain an overall pooled sensitivity and specificity of NAF for breast cancer detection.

Results: A search through 938 studies yielded a total of 19 studies. Overall, 9308 patients were examined, with cytology results from 10,147 breasts [age (years), mean ± SD = 49.73 ± 4.09 years]. Diagnostic accuracy meta-analysis of NAF revealed a pooled specificity of 0.97 (95% CI 0.97-0.98), and sensitivity of 0.64 (95% CI 0.62-0.66).

Conclusions: The diagnostic accuracy of nipple smear cytology is limited by poor sensitivity. If nipple fluid assessment is to be used for diagnosis, then emerging technologies for fluid biomarker analysis must supersede the current diagnostic accuracy of NAF cytology.

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Figures

Fig. 1
Fig. 1
ES, effect size; 95% CI, 95% confidence interval; % weight, percentage weight carried by the study calculated from the random effects analysis. Overall sensitivity from 11/19 studies 0.64 [0.62–0.64]
Fig. 2
Fig. 2
ES, effect size; 95% CI, 95% confidence interval; % weight, percentage weight carried by the study calculated from the random effects analysis. Overall specificity from 19/19 studies 0.97 [0.97–0.98]
Fig. 3
Fig. 3
a Meta-analysis HSROC curve for cytology and b prediction and confidence contours for the six studies included in the meta-analysis. The x-axis demonstrates 1-specificity (the true negatives) and the y-axis demonstrates the sensitivity (the true positives). The curve delineates the true positive rate of nipple cytology at each true negative value. A perfect test is one in which the results are closest to 1, i.e. 100% accuracy
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