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.	张康. MR-DWI及ADC值对乳腺癌及腋窝淋巴结转移诊断价值的研究.宜昌:三峡大学, 2013.
10.	毛红岩, 杨爱萍. DWI序列对乳腺癌腋窝淋巴结良恶性的诊断价值.中国优生优育, 2012, 18(6):356-358.
11.	罗宁斌, 苏丹柯, 刘丽东, 等.弥散加权成像对乳腺癌腋窝淋巴结转移的诊断价值.实用放射学杂志, 2012, 28(10):1549-1552.
12.	陈泉桦, 刘彪.乳腺MRI多b值下ADC值定量对腋窝淋巴结定性诊断价值及b值优化.磁共振成像, 2014, 5(4):264-268.
13.	陈皓, 孙烨, 袁飞, 洪楠.扩散加权成像诊断乳腺浸润性导管癌腋窝淋巴结转移.中国介入影像与治疗学, 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.	Başara I, Örgüç S, Coşkun 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.证据质量评价--发表偏倚.中国循证医学杂志, 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.	雷军强, 马文婷, 王寅中, 等.特异性肝胆对比剂钆塞酸二钠对肝转移瘤的诊断价值的Meta分析.中国循证医学杂志, 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. 张康. MR-DWI及ADC值对乳腺癌及腋窝淋巴结转移诊断价值的研究.宜昌:三峡大学, 2013.
10. 毛红岩, 杨爱萍. DWI序列对乳腺癌腋窝淋巴结良恶性的诊断价值.中国优生优育, 2012, 18(6):356-358.
11. 罗宁斌, 苏丹柯, 刘丽东, 等.弥散加权成像对乳腺癌腋窝淋巴结转移的诊断价值.实用放射学杂志, 2012, 28(10):1549-1552.
12. 陈泉桦, 刘彪.乳腺MRI多b值下ADC值定量对腋窝淋巴结定性诊断价值及b值优化.磁共振成像, 2014, 5(4):264-268.
13. 陈皓, 孙烨, 袁飞, 洪楠.扩散加权成像诊断乳腺浸润性导管癌腋窝淋巴结转移.中国介入影像与治疗学, 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. Başara I, Örgüç S, Coşkun 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.证据质量评价--发表偏倚.中国循证医学杂志, 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. 雷军强, 马文婷, 王寅中, 等.特异性肝胆对比剂钆塞酸二钠对肝转移瘤的诊断价值的Meta分析.中国循证医学杂志, 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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