Diagnostic Value of Diffusion Weighted Imaging Sequence for Assessing Lymph Node Metastases in Breast Cancer: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUHai-feng ^1,2 , LIUYi-jing ³ , XUYong-sheng ^1,2 , GAOYu-ling ¹ , TIANShui-shui ¹ , TIANJin-hui ² , YANGKe-hu ² ,  LEIJun-qiang ¹

1. Radiology Department, The First Hospital of Lanzhou University, Lanzhou 730000, China;
2. EBM Center of Lanzhou University, Lanzhou 730000, China;
3. Radiology Department, People's Hospital of Gansu Province, Lanzhou 730000, China;

Corresponding?author：

LEIJun-qiang, Email: leijq2011@126.com

Keywords：

MRI; Diffusin weighted imaging; DWI; Breast cancer; Lymph node; Meta-analysis

DOI：

10.7507/1672-2531.20160194

Video：

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Objective To evaluate the values of diffusion weighted imaging (DWI) sequence in the diagnosis of node metastases in breast cancer by meta-analysis. Methods The articles concerning the diagnosis of node metastases by using DWI until September 2016 were searched in databases including The Cochrane Library, PubMed, EMbase, Web of Science, CBM, VIP, WanFang Data and CNKI. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies by using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) tool. Then, meta-analysis was performed by using Stata 12.0 software. The pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated, the summary receiver operating characteristic curve (SROC) was drawn and the area under the curve was calculated. Results A total of 21 articles were included, involving 25 studies. The results of meta-analysis showed that, the pooled sensitivity, specificity, DOR and area under SROC curve of DWI for diagnosing node metastases were 0.85 (95%CI 0.80 to 0.89), 0.83 (95%CI 0.78 to 0.87), 4.99 (95%CI 3.74 to 6.67), 0.18 (95%CI 0.13 to 0.24), 3.32 (95%CI 2.82 to 3.82), and 0.91 (95%CI 0.88 to 0.93), respectively. The results of subgroup analysis showed that DWI had better Spe in b value=750-1 000 than b value=400-600; The 1.5T DWI had better Sen and Spe in diagnosing node metastases compared with 1.5T DWI. Conclusion DWI has more diagnostic efficiency for assessing lymph node metastases, especially in b value=750-1 000 and 1.5T field MR syetem. Due to limited quantity and quality of the included studies, more high-quality studies are required to verify the above conclusion.

Citation： LIUHai-feng, LIUYi-jing, XUYong-sheng, GAOYu-ling, TIANShui-shui, TIANJin-hui, YANGKe-hu, LEIJun-qiang. Diagnostic Value of Diffusion Weighted Imaging Sequence for Assessing Lymph Node Metastases in Breast Cancer: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(11): 1276-1283. doi: 10.7507/1672-2531.20160194 Copy

1.	Li T, Mello-Thoms C, Brennan PC. Descriptive epidemiology of breast cancer in China:incidence, mortality, survival and prevalence. Breast Cancer Res Treat, 2016, 159(3):395-406.
2.	Morrow M. Progress in the surgical management of breast cancer:Present and future. Breast, 2015, 24(Suppl 2):S2-5.
3.	Mullen R, Purdie CA, Jordan LB, et al. Can additional histopathological examination of ultrasound guided axillary lymph node core biopsies improve preoperative diagnosis of primary breast cancer nodal metastasis? Clin Radiol, 2013, 68(7):704-707.
4.	Gherghe M, Bordea C, Blidaru A. Sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer. J Med Life, 2015, 8(2):176-180.
5.	Wendl CM, Muller S, Eiglsperger J, et al. Diffusion-weighted imaging in oral squamous cell carcinoma using 3 Tesla MRI:is there a chance for preoperative discrimination between benign and malignant lymph nodes in daily clinical routine? Acta Radiol, 2016, 57(8):939-946.
6.	Schipper RJ, Paiman ML, Beets-Tan RGH, et al. Diagnostic performance of dedicated axillary T2-and diffusion-weighted MR imaging for nodal staging in breast cancer. Radiology, 2015, 275(2):345-355.
7.	Razek AA, Lattif MA, Denewer A, et al. Assessment of axillary lymph nodes in patients with breast cancer with diffusion-weighted MR imaging in combination with routine and dynamic contrast MR imaging. Breast Cancer, 2016, 23(3):525-532.
8.	Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2:a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8):529-536.
9.	張康. MR-DWI及ADC值對乳腺癌及腋窩淋巴結轉移診斷價值的研究.宜昌:三峽大學, 2013.
10.	毛紅巖, 楊愛萍. DWI序列對乳腺癌腋窩淋巴結良惡性的診斷價值.中國優生優育, 2012, 18(6):356-358.
11.	羅寧斌, 蘇丹柯, 劉麗東, 等.彌散加權成像對乳腺癌腋窩淋巴結轉移的診斷價值.實用放射學雜志, 2012, 28(10):1549-1552.
12.	陳泉樺, 劉彪.乳腺MRI多b值下ADC值定量對腋窩淋巴結定性診斷價值及b值優化.磁共振成像, 2014, 5(4):264-268.
13.	陳皓, 孫燁, 袁飛, 洪楠.擴散加權成像診斷乳腺浸潤性導管癌腋窩淋巴結轉移.中國介入影像與治療學, 2014, 11(2):92-95.
14.	Zaiton F, Shehata SM, Abo Warda MH, et al. Diagnostic value of MRI for predicting axillary lymph nodes metastasis in newly diagnosed breast cancer patients:Diffusion-weig hted MRI. Egypt J Radiol Nucl Med, 2016, 47(2):659-667.
15.	Yun SJ, Sohn YM, Seo M. Differentiation of benign and metastatic axillary lymph nodes in breast cancer:additive value of MRI computer-aided evaluation. Clin Radiol, 2016, 71(4):403. e1-7.
16.	Yamaguchi K, Schacht D, Nakazono T, et al. Diffusion weighted images of metastatic as compared with nonmetastatic axillary lymph nodes in patients with newly diagnosed breast cancer. Magn Reson Imaging, 2015, 42(3):771-778.
17.	Scaranelo AM, Eiada R, Jacks LM, et al. Accuracy of unenhanced MR imaging in the detection of axillary lymph node metastasis:study of reproducibility and reliability. Radiology, 2012, 262(2):425-434.
18.	Rautiainen S, Kononen M, Sironen R, et al. Preoperative axillary staging with 3.0-T breast MRI:clinical value of diffusion imaging and apparent diffusion coefficient. PLoS One, 2015, 10(3):e0122516.
19.	Nakai G, Matsuki M, Harada T, et al. Evaluation of axillary lymph nodes by diffusion-weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer:initial clinical experience. Magn Reson Imaging, 2011, 34(3):557-562.
20.	Luo NB, Su DK, Jin GQ, et al. Apparent Diffusion Coefficient Ratio Between Axillary Lymph Node With Primary Tumor to Detect Nodal Metastasis in Breast Cancer Patients. J Magn Reson Imaging, 2013, 38(4):824-828.
21.	Kim EJ, Kim SH, Kang BJ, et al. Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients:diffusion-weighted MRI and conventional MRI. Magn Reson Imaging, 2014, 32(10):1230-1236.
22.	Kamitani T, Hatakenaka M, Yabuuchi H, et al. Detection of axillary node metastasis using diffusion-weighted MRI in breast cancer. Clin Imaging, 2013, 37(1):56-61.
23.	Ismail AAA, Hasan DI, Abd-Alshakor H. Diagnostic accuracy of apparent diffusion coefficient value in differentiating metastatic form benign axillary lymph nodes in cancer breast. Egypt J Radiol Nucl Med, 2014, 45(3):1011-1016.
24.	He N, Xie C, Wei W, et al. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer. Eur J Radiol, 2012, 81(10):2602-2612.
25.	Fornasa F, Nesoti MV, Bovo C, et al. Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer. J Magn Reson Imaging, 2012, 36(4):858-864.
26.	Chung J, Youk JH, Kim JA, et al. Role of diffusion-weighted MRI:Predicting axillary lymph node metastases in breast cancer. Acta Radiol, 2013, 55(8):909-916.
27.	Ba?ara I, ?rgü? S, Co?kun T. The role of diffusion weighted imaging in the assessment of axillary lymph nodes. J Breast Health, 2013, 9(2):76-81.
28.	Guyatt G, Oxman A, Montori V, et al. GRADE指南:Ⅴ.證據質量評價--發表偏倚.中國循證醫學雜志, 2011, 11(12):1430-1434.
29.	Herold CJ, Lewin JS, Wibmer AG, et al. Imaging in the Age of Precision Medicine:Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology. Radiology, 2016, 279(1):226-238.
30.	Tackmann R, Schuetz G, Hamm B, et al. Quality of the reporting of diagnostic accuracy studies:STARD (Standards for the Reporting of Diagnostic accuracy studies). RoFo, 2010, 182(8):655-659.
31.	Mir N, Sohaib SA, Collins D, et al. Fusion of high b-value diffusion-weighted and T2-weighted MR images improves identification of lymph nodes in the pelvis. J Med Imaging Radiat Oncol, 2010, 54(4):358-364.
32.	Azzedine B, Kahina MB, Dimitri P, et al. Whole-body diffusion-weighted MRI for staging lymphoma at 3.0T:comparative study with MR imaging at 1.5T. Clin Imaging, 2015, 39(1):104-109.
33.	雷軍強, 馬文婷, 王寅中, 等.特異性肝膽對比劑釓塞酸二鈉對肝轉移瘤的診斷價值的Meta分析.中國循證醫學雜志, 2015, 15(12):1378-1386.

1. Li T, Mello-Thoms C, Brennan PC. Descriptive epidemiology of breast cancer in China:incidence, mortality, survival and prevalence. Breast Cancer Res Treat, 2016, 159(3):395-406.
2. Morrow M. Progress in the surgical management of breast cancer:Present and future. Breast, 2015, 24(Suppl 2):S2-5.
3. Mullen R, Purdie CA, Jordan LB, et al. Can additional histopathological examination of ultrasound guided axillary lymph node core biopsies improve preoperative diagnosis of primary breast cancer nodal metastasis? Clin Radiol, 2013, 68(7):704-707.
4. Gherghe M, Bordea C, Blidaru A. Sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND) in the current surgical treatment of early stage breast cancer. J Med Life, 2015, 8(2):176-180.
5. Wendl CM, Muller S, Eiglsperger J, et al. Diffusion-weighted imaging in oral squamous cell carcinoma using 3 Tesla MRI:is there a chance for preoperative discrimination between benign and malignant lymph nodes in daily clinical routine? Acta Radiol, 2016, 57(8):939-946.
6. Schipper RJ, Paiman ML, Beets-Tan RGH, et al. Diagnostic performance of dedicated axillary T2-and diffusion-weighted MR imaging for nodal staging in breast cancer. Radiology, 2015, 275(2):345-355.
7. Razek AA, Lattif MA, Denewer A, et al. Assessment of axillary lymph nodes in patients with breast cancer with diffusion-weighted MR imaging in combination with routine and dynamic contrast MR imaging. Breast Cancer, 2016, 23(3):525-532.
8. Whiting PF, Rutjes AW, Westwood ME, et al. QUADAS-2:a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med, 2011, 155(8):529-536.
9. 張康. MR-DWI及ADC值對乳腺癌及腋窩淋巴結轉移診斷價值的研究.宜昌:三峽大學, 2013.
10. 毛紅巖, 楊愛萍. DWI序列對乳腺癌腋窩淋巴結良惡性的診斷價值.中國優生優育, 2012, 18(6):356-358.
11. 羅寧斌, 蘇丹柯, 劉麗東, 等.彌散加權成像對乳腺癌腋窩淋巴結轉移的診斷價值.實用放射學雜志, 2012, 28(10):1549-1552.
12. 陳泉樺, 劉彪.乳腺MRI多b值下ADC值定量對腋窩淋巴結定性診斷價值及b值優化.磁共振成像, 2014, 5(4):264-268.
13. 陳皓, 孫燁, 袁飛, 洪楠.擴散加權成像診斷乳腺浸潤性導管癌腋窩淋巴結轉移.中國介入影像與治療學, 2014, 11(2):92-95.
14. Zaiton F, Shehata SM, Abo Warda MH, et al. Diagnostic value of MRI for predicting axillary lymph nodes metastasis in newly diagnosed breast cancer patients:Diffusion-weig hted MRI. Egypt J Radiol Nucl Med, 2016, 47(2):659-667.
15. Yun SJ, Sohn YM, Seo M. Differentiation of benign and metastatic axillary lymph nodes in breast cancer:additive value of MRI computer-aided evaluation. Clin Radiol, 2016, 71(4):403. e1-7.
16. Yamaguchi K, Schacht D, Nakazono T, et al. Diffusion weighted images of metastatic as compared with nonmetastatic axillary lymph nodes in patients with newly diagnosed breast cancer. Magn Reson Imaging, 2015, 42(3):771-778.
17. Scaranelo AM, Eiada R, Jacks LM, et al. Accuracy of unenhanced MR imaging in the detection of axillary lymph node metastasis:study of reproducibility and reliability. Radiology, 2012, 262(2):425-434.
18. Rautiainen S, Kononen M, Sironen R, et al. Preoperative axillary staging with 3.0-T breast MRI:clinical value of diffusion imaging and apparent diffusion coefficient. PLoS One, 2015, 10(3):e0122516.
19. Nakai G, Matsuki M, Harada T, et al. Evaluation of axillary lymph nodes by diffusion-weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer:initial clinical experience. Magn Reson Imaging, 2011, 34(3):557-562.
20. Luo NB, Su DK, Jin GQ, et al. Apparent Diffusion Coefficient Ratio Between Axillary Lymph Node With Primary Tumor to Detect Nodal Metastasis in Breast Cancer Patients. J Magn Reson Imaging, 2013, 38(4):824-828.
21. Kim EJ, Kim SH, Kang BJ, et al. Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients:diffusion-weighted MRI and conventional MRI. Magn Reson Imaging, 2014, 32(10):1230-1236.
22. Kamitani T, Hatakenaka M, Yabuuchi H, et al. Detection of axillary node metastasis using diffusion-weighted MRI in breast cancer. Clin Imaging, 2013, 37(1):56-61.
23. Ismail AAA, Hasan DI, Abd-Alshakor H. Diagnostic accuracy of apparent diffusion coefficient value in differentiating metastatic form benign axillary lymph nodes in cancer breast. Egypt J Radiol Nucl Med, 2014, 45(3):1011-1016.
24. He N, Xie C, Wei W, et al. A new, preoperative, MRI-based scoring system for diagnosing malignant axillary lymph nodes in women evaluated for breast cancer. Eur J Radiol, 2012, 81(10):2602-2612.
25. Fornasa F, Nesoti MV, Bovo C, et al. Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer. J Magn Reson Imaging, 2012, 36(4):858-864.
26. Chung J, Youk JH, Kim JA, et al. Role of diffusion-weighted MRI:Predicting axillary lymph node metastases in breast cancer. Acta Radiol, 2013, 55(8):909-916.
27. Ba?ara I, ?rgü? S, Co?kun T. The role of diffusion weighted imaging in the assessment of axillary lymph nodes. J Breast Health, 2013, 9(2):76-81.
28. Guyatt G, Oxman A, Montori V, et al. GRADE指南:Ⅴ.證據質量評價--發表偏倚.中國循證醫學雜志, 2011, 11(12):1430-1434.
29. Herold CJ, Lewin JS, Wibmer AG, et al. Imaging in the Age of Precision Medicine:Summary of the Proceedings of the 10th Biannual Symposium of the International Society for Strategic Studies in Radiology. Radiology, 2016, 279(1):226-238.
30. Tackmann R, Schuetz G, Hamm B, et al. Quality of the reporting of diagnostic accuracy studies:STARD (Standards for the Reporting of Diagnostic accuracy studies). RoFo, 2010, 182(8):655-659.
31. Mir N, Sohaib SA, Collins D, et al. Fusion of high b-value diffusion-weighted and T2-weighted MR images improves identification of lymph nodes in the pelvis. J Med Imaging Radiat Oncol, 2010, 54(4):358-364.
32. Azzedine B, Kahina MB, Dimitri P, et al. Whole-body diffusion-weighted MRI for staging lymphoma at 3.0T:comparative study with MR imaging at 1.5T. Clin Imaging, 2015, 39(1):104-109.
33. 雷軍強, 馬文婷, 王寅中, 等.特異性肝膽對比劑釓塞酸二鈉對肝轉移瘤的診斷價值的Meta分析.中國循證醫學雜志, 2015, 15(12):1378-1386.

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Diagnostic Value of Diffusion Weighted Imaging Sequence for Assessing Lymph Node Metastases in Breast Cancer: A Meta-analysis

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