Abstract
ObjectiveTo establish the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) in discriminating malignant from non-malignant thoracic lymph nodes.Materials and MethodsThis was a meta-analysis involving systematic searches of the MEDLINE, EMBASE, and Web of Science databases up through April 2020. Studies reporting thoracic DWI and lymph node evaluation were included. The pooled sensitivity, specificity, diagnostic odds ratio, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated.ResultsWe evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients. Thoracic DWI had a pooled sensitivity and specificity of 92% (95% confidence interval [95% CI]: 71-98%) and 93% (95% CI: 79-98%), respectively. The positive and negative likelihood ratios were 13.2 (95% CI: 4.0-43.8) and 0.09 (95% CI: 0.02-0.36), respectively. The diagnostic odds ratio was 149 (95% CI: 18-1,243), and the AUC was 0.97 (95% CI: 0.95-0.98).ConclusionDWI is a reproducible technique and has demonstrated high accuracy for differentiating between malignant and benign states in thoracic lymph nodes.
Highlights
A wide range of diseases are associated with thoracic lymphadenopathy[1]
We evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients
Thoracic diffusion-weighted magnetic resonance imaging (DWI) had a pooled sensitivity and specificity of 92% (95% confidence interval [95% confidence intervals (95% CIs)]: 71–98%) and 93%, respectively
Summary
A wide range of diseases are associated with thoracic lymphadenopathy[1]. Evaluating enlarged lymph nodes is clinically essential for treatment planning and for the prediction of the prognosis[2]. The main concern when evaluating a patient with a novel finding of enlarged thoracic lymph nodes, without a previous diagnosis, is the determination of whether the etiology is malignant or benign. Computed tomography (CT) is typically the technique of choice for thoracic assessment and for the morphological description of enlarged lymph nodes. CT cannot accurately differentiate benign from malignant lymph nodes and exposes patients to radiation[5,6]. Positron emission tomography/CT (PET/ CT) performed with fluorine-18-fluorodeoxyglucose (18FFDG) relies on the biochemical mechanism of increased glucose uptake by the malignant cells to differentiate malignant from benign lymph nodes, appearing to be better than is CT alone[7]. The aim of this study was to determine the performance of DWI in distinguishing between malignant and benign thoracic lymph nodes
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