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BMC Cancer

, 10:693

Epidemiology, prevention and public health


BackgroundTo determine, in a meta-analysis, the diagnostic performance of quantitative diffusion-weighted DW MR imaging in patients with breast lesions.

MethodsEnglish and Chinese studies published prior to June 2009 to assess the diagnostic performance of quantitative DWI in patients with breast lesions were reviewed and summarized with reference to the inclusion and exclusion criteria. Methodological quality was assessed by using the quality assessment of diagnostic studies QUADAS instrument. Publication bias analysis was performed by using Comprehensive Meta-analysis version 2. Meta-Disc version 1.4 was used to describe primary results and explore homogeneity by Chi-square test and inconsistency index; to explore threshold effect by receiver operator characteristic ROC space and Spearman correlation coefficient; and to pool weighted sensitivity and specificity by fixed or random effect model. A summary ROC sROC curve was constructed to calculate the area under the curve AUC.

ResultsOf 65 eligible studies, 13 with 615 malignant and 349 benign lesions were included in the original meta-analysis, among which heterogeneity arising from factors other than threshold effect and publication bias was explored. Methodological quality was moderate. The pooled weighted sensitivity and specificity with corresponding 95% confidence interval CI in one homogenous subgroup of studies using maximum b = 1000 s-mm were 0.84 0.80, 0.87 and 0.84 0.79, 0.88 respectively. AUC of sROC was 0.9085. Sensitivity analysis demonstrated that the pooled estimates were stable and reliable.

ConclusionsQuantitative DWI has a higher specificity to differentiate between benign and malignant breast lesions compared to that of contrast-enhanced MRI. However, large scale randomized control trials RCTs are necessary to assess its clinical value because of disunified diffusion gradient factor b and diagnosis threshold.

AbbreviationsDWIDiffusion-Weighted Imaging

sROCSummary Receiver Operating Characteristic

ADCApparent Diffusion Coefficient

MRIMagnetic Resonance Imaging

TPTrue Positive

FPFalse Positive

TNTrue Negative

FNFalse Negative




PPVPositive Predictive Value

NPVNegative Predictive Value

PLRPositive Likelihood Radio

NLRNegative Likelihood Ratio

IInconsistency Index

NFSFail-Safe N

FEMFixed effect Mode

REMRandom Effect Mode

DORDiagnostic Odds Ratio

AUCArea Under the Curve

95%CI95% Confidence Interval

RCTRandomized Control Trial.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2407-10-693 contains supplementary material, which is available to authorized users.

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Autor: Xin Chen - Wen-ling Li - Yi-li Zhang - Qian Wu - You-min Guo - Zhi-lan Bai


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