Magnetic resonance imaging (MRI) is increasingly being used to examine patients with suspected breast cancer.
Purpose
To determine the diagnostic performance of combined dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) for breast cancer detection.
Material and Methods
A comprehensive search of the PUBMED, EMBASE, Web of Science, and Cochrane Library databases was performed up to September 2014. Statistical analysis included pooling of sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and diagnostic accuracy using the summary receiver operating characteristic (SROC). All analyses were conducted using STATA (version 12.0), RevMan (version 5.2), and Meta-Disc 1.4 software programs.
Results
Fourteen studies were analyzed, which included a total of 1140 patients with 1276 breast lesions. The pooled sensitivity and specificity of combined DCE-MRI and DWI were 91.6% and 85.5%, respectively. The pooled sensitivity and specificity of DWI-MRI were 86.0% and 75.6%, respectively. The pooled sensitivity and specificity of DCE-MRI were 93.2% and 71.1%. The area under the SROC curve (AUC-SROC) of combined DCE-MRI and DWI was 0.94, the DCE-MRI of 0.85. Deeks testing confirmed no significant publication bias in all studies.
Conclusion
Combined DCE-MRI and DWI had superior diagnostic accuracy than either DCE-MRI or DWI alone for the diagnosis of breast cancer.
JemalABrayFCenterMM. Global cancer statistics. CA Cancer J Clin2011; 61: 69–90.
2.
JemalAThunMJRiesLA. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, to bacco use, and tobacco control. J Natl Cancer Inst2008; 100: 1672–1694.
3.
KellyKMDeanJComuladaWS. Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts. Eur Radiol2010; 20: 734–742.
4.
SardanelliFBoetesCBorischB. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer2010; 46: 1296–1316.
5.
Pinker-DomenigKBognerWGruberS. High resolution MRI of the breast at 3 T: which BI-RADS(R) descriptors are most strongly associated with the diagnosis of breast cancer?Eur Radiol2012; 22: 322–330.
6.
OchiMKuroiwaTSunamiS. Diffusion-weighted imaging (b value = 1500 s/mm(2)) is useful to decrease false-positive breast cancer cases due to fibrocystic changes. Breast Cancer2013; 20: 137–144.
7.
SonmezGCuceFMutluH. Value of diffusion-weighted MRI in the differentiation of benign and malign breast lesions. Wien Klin Wochenschr2011; 123: 655–661.
8.
InoueKKozawaEMizukoshiW. Usefulness of diffusion-weighted imaging of breast tumors: quantitative and visual assessment. Jpn J Radiol2011; 29: 429–436.
9.
ChenXLiWLZhangYL. Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions. BMC Cancer2010; 10: 693–704.
10.
PartridgeSCDeMartiniWBKurlandBF. Quantitative diffusion-weighted imaging as an adjunct to conventional breast MRI for improved positive predictive value. Am J Roentgenol2009; 193: 1716–1722.
11.
BognerWGruberSPinkerK. Diffusion-weighted MR for differentiation of breast lesions at 3.0 T: how does selection of diffusion protocols affect diagnosis?Radiology2009; 253: 341–351.
12.
Ei KhouliRHJacobsMAMezbanSD. Diffusion-weighted imaging improves the diagnostic accuracy of conventional 3.0-T breast MR imaging. Radiology2010; 256: 64–73.
13.
CaiHPengYOuC. Diagnosis of breast masses from dynamic contrast-enhanced and diffusion-weighted MR: a machine learning approach. PLoS One2014; 9: e87387–e87387.
14.
KulSCansuAAlhanE. Contribution of diffusion-weighted imaging to dynamic contrast-enhanced MRI in the characterization of breast tumors. Am J Roentgenol2011; 196: 210–217.
15.
D’OrsiCJMendelsonEBIkedaDM. Breast imaging reporting and data system: ACR BIRADS – breast imaging atlas, Reston, VA: American College of Radiology, 2003.
16.
SardanelliFBoetesCBorischB. Magnetic resonance imaging of the breast: recommendations from the EUSOMA working group. Eur J Cancer2010; 46: 1296–1316.
17.
YooHShinHJBaekS. Diagnostic performance of apparent diffusion coefficient and quantitative kinetic parameters for predicting additional malignancy in patients with newly diagnosed breast cancer. Magn Reson Imaging2014; 32: 867–874.
18.
YabuuchiHMatsuoYOkafujiT. Enhanced mass on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images. J Magn Reson Imaging2008; 28: 1157–1165.
19.
TanSLRahmatKRozalliFI. Differentiation between benign and malignant breast lesions using quantitative diffusion-weighted sequence on 3 T MRI. Clin Radiol2014; 69: 63–71.
20.
MoukhtarFZMaati ElAAA. Apparent diffusion coefficient values as an adjunct to dynamic contrast enhanced MRI for discriminating benign and malignant breast lesions presenting as mass and non-mass like enhancement. Egyptian Journal of Radiology and Nuclear Medicine2014; 45: 597–604.
21.
WhitingPFRutjesAWWestwoodME. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med2011; 155: 529–536.
22.
ReitsmaJBGlasASRutjesAW. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol2005; 58: 982–990.
23.
MosesLEShapiroDLittenbergB. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med1993; 12: 1293–1316.
24.
DeeksJJMacaskillPRwigL. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol2005; 58: 882–893.
25.
MacaskillPGatsonisCDeeksJJ. Analysing and Presenting Results. In: Deeks JJ, Bossuyt PM, Gatsonis C, eds. Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, Oxford, United Kingdom: The Cochrane Collaboration, 2010, pp. 46–47.
26.
YabuuchiHMatsuoYKamitaniT. Non-mass-like enhancement on contrast-enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images. Eur J Radiol2010; 75: e126–e132.
27.
TangJHYanFHZhouML. Comparative study of diffusion weighted imaging and dynamic contrast enhanced MRI for the detection of small breast cancers. Chinese Journal of Radiology2008; 42: 152–156.
28.
PartridgeSCRahbarHMurthyR. Improved diagnostic accuracy of breast MRI through combined apparent diffusion coefficients and dynamic contrast-enhanced kinetics. Magn Reson Med2011; 65: 1759–1767.
29.
LuoYYuJChenD. The actions of diffusion weighted imaging (DWI) and dynamic contrast enhanced MRI in differentiating breast tumors. Sheng Wu Yi Xue Gong Cheng Xue Za Zhi2013; 30: 1219–1223.
30.
ImamuraTIsomotoISueyoshiE. Diagnostic performance of ADC for non-mass-like breast lesions on MR imaging. Magn Reson Med Sci2010; 9: 217–225.
31.
HassanHHMZahranMHMHassanHEP. Diffusion magnetic resonance imaging of breast lesions: Initial experience at Alexandria University. Alexandria Journal of Medicine2013; 49: 265–272.
32.
BassiounyRHYoussefTHassanO. Diagnostic performance of breast MRI with and without the addition of quantitative diffusion weighted imaging. Egyptian Journal of Radiology and Nuclear Medicine2012; 43: 311–323.
33.
PinkerKBognerWBaltzerP. Improved diagnostic accuracy with multiparametric magnetic resonance imaging of the breast using dynamic contrast-enhanced magnetic resonance imaging, diffusion-weighted imaging, and 3-dimensional proton magnetic resonance spectroscopic imaging. Invest Radiol2014; 49: 421–430.
34.
BognerWGruberSPinkerK. Diffusion-weighted MR for differentiation of breast lesions at 3.0 T: how does selection of diffusion protocols affect diagnosis?Radiology2009; 253: 341–351.
35.
RenzDMDiekmannFSchmitzbergerFF. Pharmacokinetic approach for dynamic breast MRI to indicate signal intensity time curves of benign and malignant lesions by using the tumor flow residence time. Invest Radiol2013; 48: 69–78.
36.
KuhlCKJostPMorakkabatiN. Contrast-enhanced MR imaging of the breast at 3.0 and 1.5 T in the same patients: Initial experience. Radiology2006; 239: 666–676.
37.
ShaoZWangHLiX. Morphological distribution and internal enhancement architecture of contrast-enhanced magnetic resonance imaging in the diagnosis of non-mass-like breast lesions: a meta-analysis. Breast J2013; 19: 259–268.
38.
DorriusMDDijkstraHOudkerkM. Effect of b value and pre-admission of contrast on diagnostic accuracy of 1.5-T breast DWI: a systematic review and meta-analysis. Eur Radiol2014; 24: 2835–2847.
39.
BossuytPReitsmaJBrunsD. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem2003; 49: 7–18.
40.
BaltzerPADietzelMVagT. Clinical MR mammography: impact of hormonal status on background enhancement and diagnostic accuracy. Rofo2011; 183: 441–447.
