Abstract
Apparent diffusion coefficient (ADC) values of nodes in diffusion-weighted imaging (DWI) are widely used in differentiating metastatic from non-metastatic lymph nodes. The purpose of this meta-analysis was to demonstrate whether DWI could contribute to the precise diagnosis of breast cancer (BC) with and without lymph node metastasis (LNM). English and Chinese electronic databases were searched for relevant studies followed by a comprehensive literature search. Two reviewers independently assessed the methodological quality of the included trials based on the quality assessment of diagnostic accuracy studies (QUADAS). Summary odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were calculated. Final analysis of 624 BC subjects (patients with LNM = 254, patients without LNM = 370) were incorporated into the current meta-analysis from 9 eligible cohort studies. Combined ORs of ADCs suggested that ADC values in BC patients without LNM were higher than in patients with LNM (OR=0.56, 95%CI: 0.11-1.01, p=0.015). Subgroup analysis stratified by country indicated a low ADC value in BC patients with LNM rather than those without LNM among Chinese (OR=1.27, 95%CI: 0.89-1.66, p<0.001), Italians (OR=0.75, 95%CI: 0.13-1.38, p=0.018), and Egyptians (OR=1.27, 95%CI: 0.71-1.84, p<0.001). The findings of subgroup analysis by MRI machine type revealed that ADC values from diffusion MRI may be potential diagnostic indicators for BC using Non-Philips 1.5T (OR=1.10, 95%CI: 0.84-1.36, p<0.001). The main findings of our meta-analysis demonstrated that increased signal intensity on DWI and decreased signals on ADC are helpful in diagnosis of BC patients with or without LNM. DWI could therefore be an important imaging investigation in patients suspected of BC.
Highlights
Breast cancer (BC), starting in the inner lining of milk ducts or the lobules, is the leading type of cancer in females around the world, estimated to be responsible for 29% (232,340) of all new cancer cases among women (Siegel et al, 2013)
Evidence indicated that diffusion-weighted imaging (DWI) might be useful for detection of recurrence and metastasis of lung cancer, or Apparent diffusion coefficient (ADC) measurements may be utilized to improve the differential diagnosis accuracy of benign and malignant focal liver lesions, DWI has higher potential than other imaging methods like positron emission tomography in assessing pulmonary nodules and masses, yet no more other publishes focused on the differential diagnosis of breast cancer (BC) which may restrict a wide references and applications of DWI in the differential diagnosis of human tumors (Han et al, 2014; Usuda et al, 2014a; 2014b)
The most important conclusion of the current study is that the ADC values of lymph nodes with metastasis was apparently lower compared to those of benign or normal lymph nodes, indicating that DWI might be an useful method in the characterization and diagnosis of malignant lymph node metastasis (LNM) in BC patients by means of measuring the ADC values
Summary
Breast cancer (BC), starting in the inner lining of milk ducts or the lobules, is the leading type of cancer in females around the world, estimated to be responsible for 29% (232,340) of all new cancer cases among women (Siegel et al, 2013). Various risk factors may contribute to the pathogenesis of BC, such as high breast tissue density, obesity and radiation, family history, late age at first birth, alcohol intake, and so on (McCullough et al, 2009; Gibson et al, 2010). A variety of screening and diagnosing tools including magnetic resonance imaging (MRI) have been used in detection of BC, and diffusion-weighted imaging (DWI) has been introduced to diagnose LN metastasis in BC (Fornasa et al, 2012; Siegel et al, 2013)
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