Abstract
BackgroundThe purpose of this meta-analysis was to evaluate the clinical significance of diffusion-weighted imaging in assessing the status of axillary lymph nodes in patients with breast cancer.MethodsWe searched the PubMed, Cochrane, and EMBASE databases, selected studies by inclusion and exclusion criteria, and assessed the quality of selected studies. We explored the source of heterogeneity; calculated sensitivity, specificity, positive and negative likelihood ratios, and pretest probability. A summary receiver operating characteristic curve was performed. Student’s t test was used to compare the different mean apparent diffusion coefficient values of different status lymph nodes.ResultsIn selected 10 studies, a total of 801 patients and 2305 lymph nodes were included following inclusion criteria. All scores of the quality assessment of the included studies were greater than or equal to 10 points. The sensitivity was 0.89 (95 % CI 0.79–0.95), the specificity was 0.83 (95 % CI 0.71–0.91), the positive and negative likelihood ratios were 3.86 (95 % CI 2.75–5.41) and 0.17 (95 % CI 0.09–0.32), the pretest probabilities were 53 and 54 %, the area under the curve were 0.93 (95 % CI 0.90–0.95), respectively. The mean apparent diffusion coefficient value of metastatic lymph nodes was significantly lower than that of nonmetastatic axillary lymph nodes.ConclusionsDiffusion-weighted imaging is a promising tool to discriminate between metastatic and nonmetastatic axillary lymph nodes. Combined with the mean apparent diffusion coefficient value, it can quantitatively diagnose lymph node metastases. Conducting large-scale, high-quality researches can improve the clinical significance of diffusion-weighted imaging to distinguish metastatic and nonmetastatic axillary lymph nodes in patients with breast cancer and provide the evidence to assess the status of axillary lymph nodes.
Highlights
The purpose of this meta-analysis was to evaluate the clinical significance of diffusion-weighted imaging in assessing the status of axillary lymph nodes in patients with breast cancer
Inclusion and exclusion criteria We reviewed studies for the following inclusion criteria: (1) studies were published in English, (2) Diffusionweighted imaging (DWI) was performed in detecting axillary lymph nodes (ALNs) with breast cancer, (3) histopathological results were used as the reference standard, and (4) the true positive (TP), false positive (FP), true negative (TN), and false negative (FN) values can be calculated with sufficient data
We excluded the studies with the following criteria: (1) lack the explanations of DWI-detected ALNs with breast cancer; (2) without histopathological reference standard; (3) insufficient data to get the TP, FP, TN, and FN values; (4) experimental subject was an animal and ex vivo; (5) the type of study was review, case report, letter to editor, and meta-analysis; and (6) unable to get the full text
Summary
The purpose of this meta-analysis was to evaluate the clinical significance of diffusion-weighted imaging in assessing the status of axillary lymph nodes in patients with breast cancer. Evaluating the status of axillary lymph nodes (ALNs) is crucial in staging, deciding the treatment planning, and predicting the long-term survival in breast cancer [1,2,3]. Biopsy is recognized as the gold standard for assessing ALNs. the drawbacks of biopsy are high false negative ratio result from sample errors and its invasiveness [4]. The imaging modalities for assessing the ALNs. Sui et al World Journal of Surgical Oncology (2016) 14:155. ALNs [8], but their high radiation and expensive fee keep the common people away. Its satisfactory performance was extinguished by drawbacks of timeconsuming, underlying risk and forbidden in clinical practice [9]
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