Abstract
Objectives: The diagnostic performance of intravoxel incoherent motion diffusion–weighted imaging (IVIM-DWI) in the differential diagnosis of breast tumors remains debatable among published studies. Therefore, this meta-analysis aimed to pool relevant evidence regarding the diagnostic performance of IVIM-DWI in the differential diagnosis of breast tumors.Methods: Studies on the differential diagnosis of breast lesions using IVIM-DWI were systemically searched in the PubMed, Embase and Web of Science databases in recent 10 years. The standardized mean difference (SMD) and 95% confidence intervals of the apparent diffusion coefficient (ADC), tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f) were calculated using Review Manager 5.3, and Stata 12.0 was used to pool the sensitivity, specificity, and area under the curve (AUC), as well as assess publication bias and heterogeneity. Fagan's nomogram was used to predict the posttest probabilities.Results: Sixteen studies comprising 1,355 malignant and 362 benign breast lesions were included. Most of these studies showed a low to unclear risk of bias and low concerns regarding applicability. Breast cancer had significant lower ADC (SMD = −1.38, P < 0.001) and D values (SMD = −1.50, P < 0.001), and higher f value (SMD = 0.89, P = 0.001) than benign lesions, except D* value (SMD = −0.30, P = 0.20). Invasive ductal carcinoma showed lower ADC (SMD = 1.34, P = 0.01) and D values (SMD = 1.04, P = 0.001) than ductal carcinoma in situ. D value demonstrated the best diagnostic performance (sensitivity = 86%, specificity = 86%, AUC = 0.91) and highest post-test probability (61, 48, 46, and 34% for D, ADC, f, and D* values) in the differential diagnosis of breast tumors, followed by ADC (sensitivity = 76%, specificity = 79%, AUC = 0.85), f (sensitivity = 80%, specificity = 76%, AUC = 0.85) and D* values (sensitivity = 84%, specificity = 59%, AUC = 0.71).Conclusion: IVIM-DWI parameters are adequate and superior to the ADC in the differentiation of breast tumors. ADC and D values can further differentiate invasive ductal carcinoma from ductal carcinoma in situ. IVIM-DWI is also superior in identifying lymph node metastasis, histologic grade, and hormone receptors, and HER2 and Ki-67 status.
Highlights
Breast cancer is one of the most common malignant tumors and the second leading cause of cancer death in females (1)
Studies that met the following criteria were included: (a) the research purpose was to differentiate malignant and benign breast lesions using Intravoxel incoherent motion (IVIM)-Diffusion-weighted imaging (DWI) parameters; (b) the mean and standard deviation (SD) of each parameter were provided; (c) the diagnostic performance regarding sensitivity and specificity, or true-positive (TP), false-negative (FN), false-positive (FP), and true-negative (TN) counts were reported; and (d) breast cancer was confirmed by pathology after initial MRI examination
Benign lesions consisted of fibroadenoma, intraductal papilloma, granulomatous mastitis, epithelial proliferative lesion, fibrocystic change, and phyllodes tumors
Summary
Breast cancer is one of the most common malignant tumors and the second leading cause of cancer death in females (1). Screening the breast lesions with conventional mammography is challenging for clinician due to the low sensitivity in dense breast parenchyma (2). Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a common MRI sequence in clinical practice, which can reflect the morphological and haemodynamic features of breast lesions. A previous meta-analysis which included studies using DCE-MRI as an adjunct to conventional mammography or ultrasound to clarify uncertain finding without microcalcification, demonstrated that breast MRI had an excellent diagnostic performance with a pooled sensitivity of 99% and specificity of 89% (3). The specificity is still variable due to background parenchymal enhancement and overlapped kinetic enhancement patterns between breast cancer and benign lesion. The false-positive findings may cause additional examination or unnecessary surgery (4)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
