Diagnostic Significance of Apparent Diffusion Coefficient Values with Diffusion Weighted MRI in Breast Cancer: a Meta-Analysis

Aims: Apparent diffusion coefficient (ADC) values of nodes in diffusion-weighted imaging (DWI) are widelyused in differentiating metastatic from non-metastatic lymph nodes. The purpose of this meta-analysis was todemonstrate whether DWI could contribute to the precise diagnosis of breast cancer (BC) with and withoutlymph node metastasis (LNM). Materials and
Methods: English and Chinese electronic databases were searchedfor relevant studies followed by a comprehensive literature search. Two reviewers independently assessed themethodological quality of the included trials based on the quality assessment of diagnostic accuracy studies(QUADAS). Summary odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were calculated.
Results: Final analysis of 624 BC subjects (patients with LNM = 254, patients without LNM = 370) wereincorporated into the current meta-analysis from 9 eligible cohort studies. Combined ORs of ADCs suggested thatADC values in BC patients without LNM were higher than in patients with LNM (OR=0.56, 95%CI: 0.11-1.01,p=0.015). Subgroup analysis stratified by country indicated a low ADC value in BC patients with LNM ratherthan those without LNM among Chinese (OR=1.27, 95%CI: 0.89-1.66, p<0.001), Italians (OR=0.75, 95%CI:0.13-1.38, p=0.018), and Egyptians (OR=1.27, 95%CI: 0.71-1.84, p<0.001). The findings of subgroup analysisby MRI machine type revealed that ADC values from diffusion MRI may be potential diagnostic indicatorsfor BC using Non-Philips 1.5T (OR=1.10, 95%CI: 0.84-1.36, p<0.001).
Conclusions: The main findings of ourmeta-analysis demonstrated that increased signal intensity on DWI and decreased signals on ADC are helpfulin diagnosis of BC patients with or without LNM. DWI could therefore be an important imaging investigationin patients suspected of BC.