{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T16:45:34Z","timestamp":1793810734594,"version":"4.6.1"},"reference-count":59,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Breast cancer outcomes improve substantially with earlier detection, yet mammography performance can be limited in dense breasts and may lead to false-positive investigations. Circulating microRNAs (miRNAs) and lipidomic\/metabolomic signatures have emerged as promising minimally invasive biomarkers that could complement imaging for early-stage detection. The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of circulating microRNAs and lipidomic\/metabolomic biomarkers for early breast cancer detection and to explore between-study heterogeneity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      A PRISMA 2020\u2013compliant systematic review and meta-analysis were conducted. MEDLINE (PubMed), Web of Science, Scopus, Springer, ScienceDirect, and the Cochrane Library were searched for eligible diagnostic studies assessing circulating microRNAs and lipidomic\/metabolomic biomarkers measured in serum or plasma. No language restrictions were applied. Non-English reports were screened and, when potentially eligible, translated for full-text assessment and data extraction. Studies using whole blood were excluded. Study quality was assessed using QUADAS-2. Random-effects models (DerSimonian\u2013Laird) pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and summary ROC (SROC) area under the curve (AUC). Heterogeneity was evaluated using Q and I\n                      <jats:sup>2<\/jats:sup>\n                      statistics, and small-study effects were assessed using Deeks\u2019 test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty-two studies (2015\u20132025) comprising 6,935 participants (3,697 breast cancer cases; 3,238 controls) were included. Pooled sensitivity was 0.87 (95% CI [0.83, 0.90]) and pooled specificity was 0.84 (95% CI [0.79, 0.88]), with pooled DOR 46.10 (95% CI [27.80, 76.70]), PLR 5.17 (95% CI [3.99, 6.68]), NLR 0.16 (95% CI [0.13, 0.21]), and SROC AUC 0.92 (95% CI [0.87, 0.94]). Heterogeneity was substantial (I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200988.29% for sensitivity; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200990.20% for specificity). In subgroup analyses, serum-based studies showed higher pooled specificity than plasma-based studies. A formal threshold effect assessment did not reveal a statistically significant correlation between sensitivity and false-positive rate (Spearman \u03c1\u2009= \u2212\n                      <jats:italic>0.334, p<\/jats:italic>\n                      \u2009=\u2009\n                      <jats:italic>0.062).<\/jats:italic>\n                      Deeks\u2019 test suggested potential small-study effects (p\u2009=\u20090.043).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Circulating microRNA and lipidomic\/metabolomic biomarkers demonstrate strong overall diagnostic performance for breast cancer detection; however, substantial heterogeneity and potential small-study effects limit their immediate clinical translation. Given that most included studies used retrospective case-control designs rather than prospective screening cohorts, these biomarkers are best regarded as investigational, complementary tools rather than replacements for mammography at this stage. Future large, prospective, standardized studies with harmonized pre-analytics and prespecified thresholds are needed to support the implementation of screening or triage pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354728","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T17:43:43Z","timestamp":1784915023000},"page":"e0354728","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Diagnostic accuracy of circulating microRNAs and lipidomic biomarkers for early breast cancer detection: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2710-5673","authenticated-orcid":true,"given":"Heba Mohammed","family":"Arafat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akbar","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tengku Ahmad Damitri Al Astani","family":"Tengku Din","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ohood Mohammed","family":"Shamallakh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashid","family":"Jusoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya Mazuwin","family":"Yahya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Zainira Wan","family":"Zain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan Faiziah Wan Abdul","family":"Rahman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"pone.0354728.ref001","unstructured":"World Health Organization. Breast cancer. WHO Fact Sheet. 2025. Available from: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/breast-cancer"},{"issue":"3","key":"pone.0354728.ref002","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"F Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"issue":"22","key":"pone.0354728.ref003","doi-asserted-by":"crossref","first-page":"1931","DOI":"10.1001\/jama.2023.25844","article-title":"Screening for Breast Cancer: Evidence Report and Systematic Review for the US Preventive Services Task Force","volume":"331","author":"JT Henderson","year":"2024","journal-title":"JAMA"},{"issue":"22","key":"pone.0354728.ref004","doi-asserted-by":"crossref","first-page":"1918","DOI":"10.1001\/jama.2024.5534","article-title":"Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement","volume":"331","author":"US Preventive Services Task 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early breast cancer diagnosis","volume":"14","author":"JY Jang","year":"2021","journal-title":"Mol Clin Oncol"},{"issue":"1","key":"pone.0354728.ref033","doi-asserted-by":"crossref","first-page":"20322","DOI":"10.1038\/s41598-021-99586-1","article-title":"Plasma lipidomic profiles of kidney, breast and prostate cancer patients differ from healthy controls","volume":"11","author":"D Wolrab","year":"2021","journal-title":"Sci Rep"},{"issue":"10","key":"pone.0354728.ref034","doi-asserted-by":"crossref","first-page":"1010428320963811","DOI":"10.1177\/1010428320963811","article-title":"Candidate circulating microRNAs as potential diagnostic and predictive biomarkers for the monitoring of locally advanced breast cancer patients","volume":"42","author":"AM Ibrahim","year":"2020","journal-title":"Tumour Biol"},{"issue":"2","key":"pone.0354728.ref035","doi-asserted-by":"crossref","first-page":"157","DOI":"10.18585\/inabj.v12i2.1142","article-title":"Circulating Plasma miRNA-21 as a Superior Biomarker Compared to CA 15-3: Assessment in Healthy Age Matched Subjects and Different Stage of Breast Cancer Patients","volume":"12","author":"M Savitri","year":"2020","journal-title":"Indones Biomed J"},{"key":"pone.0354728.ref036","doi-asserted-by":"crossref","DOI":"10.7717\/peerj.10494","article-title":"Combination of circulating miR-145-5p\/miR-191-5p as biomarker for breast cancer detection","volume":"8","author":"Y Ashirbekov","year":"2020","journal-title":"PeerJ"},{"issue":"1","key":"pone.0354728.ref037","article-title":"Plasma miR-1273g-3p acts as a potential biomarker for early Breast Ductal Cancer diagnosis","volume":"92","author":"H Guo","year":"2020","journal-title":"An Acad Bras Cienc"},{"issue":"2","key":"pone.0354728.ref038","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s40291-020-00453-y","article-title":"Urinary Exosomal MicroRNAs as Potential Non-invasive Biomarkers in Breast Cancer Detection","volume":"24","author":"M Hirschfeld","year":"2020","journal-title":"Mol Diagn Ther"},{"issue":"2","key":"pone.0354728.ref039","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s10549-018-4757-3","article-title":"Circulating microRNAs from the miR-106a-363 cluster on chromosome X as novel diagnostic biomarkers for breast cancer","volume":"170","author":"M Li","year":"2018","journal-title":"Breast Cancer Res Treat"},{"issue":"16","key":"pone.0354728.ref040","doi-asserted-by":"crossref","first-page":"7006","DOI":"10.1002\/cam4.2572","article-title":"A five-miRNA panel in plasma was identified for breast cancer diagnosis","volume":"8","author":"M Li","year":"2019","journal-title":"Cancer Med"},{"issue":"3","key":"pone.0354728.ref041","doi-asserted-by":"crossref","DOI":"10.17582\/journal.pjz\/2019.51.3.1113.1121","article-title":"Identification of Circulating miRNAs as Non-Invasive Biomarkers of Triple Negative Breast Cancer in the Population of Pakistan","volume":"51","author":"J Shaheen","year":"2019","journal-title":"PJZ"},{"issue":"11","key":"pone.0354728.ref042","doi-asserted-by":"crossref","first-page":"2833","DOI":"10.1002\/ijc.31996","article-title":"A plasma metabolite panel as biomarkers for early primary breast cancer detection","volume":"144","author":"B Yuan","year":"2019","journal-title":"Int J Cancer"},{"issue":"5","key":"pone.0354728.ref043","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1080\/13813455.2018.1482355","article-title":"Role of some circulating MiRNAs on breast cancer diagnosis","volume":"125","author":"M Swellam","year":"2019","journal-title":"Arch Physiol Biochem"},{"key":"pone.0354728.ref044","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.3389\/fphys.2018.01879","article-title":"Plasma MicroRNA Pair Panels as Novel Biomarkers for Detection of Early Stage Breast Cancer","volume":"9","author":"R Fang","year":"2019","journal-title":"Front Physiol"},{"issue":"12","key":"pone.0354728.ref045","doi-asserted-by":"crossref","first-page":"19522","DOI":"10.18632\/oncotarget.14521","article-title":"A plasma metabolomic signature discloses human breast cancer","volume":"8","author":"M Jov\u00e9","year":"2017","journal-title":"Oncotarget"},{"issue":"5","key":"pone.0354728.ref046","doi-asserted-by":"crossref","first-page":"5416","DOI":"10.18632\/oncotarget.6786","article-title":"Circulating microRNA-based screening tool for breast cancer","volume":"7","author":"P Fr\u00e8res","year":"2016","journal-title":"Oncotarget"},{"issue":"8","key":"pone.0354728.ref047","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1373\/clinchem.2015.238691","article-title":"Tumor microRNA expression profiling identifies circulating microRNAs for early breast cancer detection","volume":"61","author":"N Matamala","year":"2015","journal-title":"Clin 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MicroRNAs and apoptosis signaling pathways in breast cancer: from molecular insights to clinical applications. 2024."},{"issue":"22","key":"pone.0354728.ref052","doi-asserted-by":"crossref","first-page":"3672","DOI":"10.3390\/cancers17223672","article-title":"Interplay Between MicroRNAs and Breast Cancer Therapies: Personalized Therapeutic Potential for HER2-Low Breast Cancer","volume":"17","author":"E Carvalho","year":"2025","journal-title":"Cancers (Basel)"},{"issue":"4","key":"pone.0354728.ref053","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1002\/anie.201804736","article-title":"High-Throughput Metabolomics by 1D NMR","volume":"58","author":"A Vignoli","year":"2019","journal-title":"Angew Chem Int Ed Engl"},{"issue":"4","key":"pone.0354728.ref054","article-title":"Applications of multi-omics analysis in human diseases","volume":"4","author":"C Chen","year":"2023","journal-title":"MedComm (2020)"},{"issue":"6","key":"pone.0354728.ref055","first-page":"938","article-title":"QUADAS-C-A tool for assessing risk of bias regarding Quality Assessment of Diagnostic Accuracy Studies-Comparative","volume":"43","author":"QY Yang","year":"2022","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"pone.0354728.ref056","first-page":"5801662","article-title":"Diagnostic Accuracy Studies in Radiology: How to Recognize and Address Potential Sources of Bias","volume":"2021","author":"A Pavlou","year":"2021","journal-title":"Radiol Res Pract"},{"key":"pone.0354728.ref057","article-title":"A tailored fit that doesn\u2019t fit all: the problem of threshold overfitting in diagnostic studies","author":"J Arredondo Montero","year":"2025","journal-title":"Diagnosis (Berl)"},{"issue":"2","key":"pone.0354728.ref058","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1136\/eb-2013-101637","article-title":"Reporting quality of diagnostic accuracy studies: a systematic review and meta-analysis of investigations on adherence to STARD","volume":"19","author":"DA Korevaar","year":"2014","journal-title":"Evid Based Med"},{"issue":"4","key":"pone.0354728.ref059","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1002\/jrsm.1414","article-title":"Funnel plots may show asymmetry in the absence of publication bias with continuous outcomes dependent on baseline risk: presentation of a new publication bias test","volume":"11","author":"B Doleman","year":"2020","journal-title":"Res Synth Methods"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354728","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T17:43:52Z","timestamp":1784915032000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0354728"}},"subtitle":[],"editor":[{"given":"Marwan Salih","family":"Al-Nimer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":59,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0354728","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}