Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Surgical Oncology
Published in: World Journal of Surgical Oncology 1/2016

Open Access 01-12-2016 | Research

The Diagnosis of Metastatic Axillary Lymph Nodes of Breast Cancer By Diffusion Weighted Imaging: a meta-analysis and systematic review

Authors: Wei Fan Sui, Xiang Chen, Zhen Kun Peng, Jing Ye, Jing Tao Wu

Published in: World Journal of Surgical Oncology | Issue 1/2016

Login to get access

Abstract

Background

The purpose of this meta-analysis was to evaluate the clinical significance of diffusion-weighted imaging in assessing the status of axillary lymph nodes in patients with breast cancer.

Methods

We searched the PubMed, Cochrane, and EMBASE databases, selected studies by inclusion and exclusion criteria, and assessed the quality of selected studies. We explored the source of heterogeneity; calculated sensitivity, specificity, positive and negative likelihood ratios, and pretest probability. A summary receiver operating characteristic curve was performed. Student’s t test was used to compare the different mean apparent diffusion coefficient values of different status lymph nodes.

Results

In selected 10 studies, a total of 801 patients and 2305 lymph nodes were included following inclusion criteria. All scores of the quality assessment of the included studies were greater than or equal to 10 points. The sensitivity was 0.89 (95 % CI 0.79–0.95), the specificity was 0.83 (95 % CI 0.71–0.91), the positive and negative likelihood ratios were 3.86 (95 % CI 2.75–5.41) and 0.17 (95 % CI 0.09–0.32), the pretest probabilities were 53 and 54 %, the area under the curve were 0.93 (95 % CI 0.90–0.95), respectively. The mean apparent diffusion coefficient value of metastatic lymph nodes was significantly lower than that of nonmetastatic axillary lymph nodes.

Conclusions

Diffusion-weighted imaging is a promising tool to discriminate between metastatic and nonmetastatic axillary lymph nodes. Combined with the mean apparent diffusion coefficient value, it can quantitatively diagnose lymph node metastases. Conducting large-scale, high-quality researches can improve the clinical significance of diffusion-weighted imaging to distinguish metastatic and nonmetastatic axillary lymph nodes in patients with breast cancer and provide the evidence to assess the status of axillary lymph nodes.
Literature
1.
Jatoi I, Hilsenbeck SG, Clark GM, Osborne CK. Significance of axillary lymph node metastasis in primary breast cancer. J Clin Oncol. 1999;17(8):2334–40.PubMed
2.
Silverstein MJ, Skinner KA, Lomis TJ. Predicting axillary nodal positivity in 2282 patients with breast carcinoma. World J Surg. 2001;25(6):767–72.CrossRefPubMed
3.
Thompson AM. New standards of care in the management of the axilla. Curr Opin Oncol. 2012;24(6):605–11.CrossRefPubMed
4.
Mullen R, Purdie CA, Jordan LB, McLean D, Whelehan P, Vinnicombe S, Brown DC, Evans A. 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):704–7.CrossRefPubMed
5.
Tsai WC, Lin CK, Wei HK, Yu BL, Hung CF, Cheng SH, Chen CM. Sonographic elastography improves the sensitivity and specificity of axilla sampling in breast cancer: a prospective study. Ultrasound Med Biol. 2013;39(6):941–9.CrossRefPubMed
6.
Alvarez S, Anorbe E, Alcorta P, Lopez F, Alonso I, Cortes J. Role of sonography in the diagnosis of axillary lymph node metastases in breast cancer: a systematic review. AJR Am J Roentgenol. 2006;186(5):1342–8.CrossRefPubMed
7.
Nasu Y, Shikishima H, Miyasaka Y, Nakakubo Y, Ichinokawa K, Kaneko T. A study of the assessment of axillary lymph nodes before surgery for breast cancer using multidetector-row computed tomography. Surg Today. 2010;40(11):1023–6.CrossRefPubMed
8.
Heusner TA, Kuemmel S, Hahn S, Koeninger A, Otterbach F, Hamami ME, Kimmig KR, Forsting M, Bockisch A, Antoch G, et al. Diagnostic value of full-dose FDG PET/CT for axillary lymph node staging in breast cancer patients. Eur J Nucl Med Mol Imaging. 2009;36(10):1543–50.CrossRefPubMed
9.
Harada T, Tanigawa N, Matsuki M, Nohara T, Narabayashi I. Evaluation of lymph node metastases of breast cancer using ultrasmall superparamagnetic iron oxide-enhanced magnetic resonance imaging. Eur J Radiol. 2007;63(3):401–7.CrossRefPubMed
10.
Murray AD, Staff RT, Redpath TW, Gilbert FJ, Ah-See AK, Brookes JA, Miller ID, Payne S. Dynamic contrast enhanced MRI of the axilla in women with breast cancer: comparison with pathology of excised nodes. Br J Radiol. 2002;75(891):220–8.CrossRefPubMed
11.
Bedi DG, Krishnamurthy R, Krishnamurthy S, Edeiken BS, Le-Petross H, Fornage BD, Bassett RJ, Hunt KK. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR Am J Roentgenol. 2008;191(3):646–52.CrossRefPubMed
12.
Harnan SE, Cooper KL, Meng Y, Ward SE, Fitzgerald P, Papaioannou D, Ingram C, Lorenz E, Wilkinson ID, Wyld L. Magnetic resonance for assessment of axillary lymph node status in early breast cancer: a systematic review and meta-analysis. Eur J Surg Oncol. 2011;37(11):928–36.CrossRefPubMed
13.
Luo N, Su D, Jin G, Liu L, Zhu X, Xie D, Liu Y. 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):824–8.CrossRefPubMed
14.
Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol. 2003;3:25.CrossRefPubMedPubMedCentral
15.
Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J. Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods. 2006;11(2):193–206.CrossRefPubMed
16.
17.
Nakai G, Matsuki M, Harada T, Tanigawa N, Yamada T, Barentsz J, Narumi Y. Evaluation of axillary lymph nodes by diffusion-weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: initial clinical experience. J Magn Reson Imaging. 2011;34(3):557–62.CrossRefPubMed
18.
Kamitani T, Hatakenaka M, Yabuuchi H, Matsuo Y, Fujita N, Jinnouchi M, Nagao M, Shirahane K, Tokunaga E, Honda H. Detection of axillary node metastasis using diffusion-weighted MRI in breast cancer. Clin Imaging. 2013;37(1):56–61.CrossRefPubMed
19.
Fornasa F, Nesoti MV, Bovo C, Bonavina MG. Diffusion-weighted magnetic resonance imaging in the characterization of axillary lymph nodes in patients with breast cancer. J Magn Reson Imaging. 2012;36(4):858–64.CrossRefPubMed
20.
He N, Xie C, Wei W, Pan C, Wang W, Lv N, Wu P. 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):2602–12.CrossRefPubMed
21.
Chung J, Youk JH, Kim JA, Gweon HM, Kim EK, Ryu YH, Son EJ. Role of diffusion-weighted MRI: predicting axillary lymph node metastases in breast cancer. Acta Radiol. 2014;55(8):909–16.CrossRefPubMed
22.
Kim EJ, Kim SH, Kang BJ, Choi BG, Song BJ, Choi JJ. 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):1230–6.CrossRefPubMed
23.
Schipper RJ, Paiman ML, Beets-Tan RG, Nelemans PJ, de Vries B, Heuts EM, van de Vijver KK, Keymeulen KB, Brans B, Smidt ML et al. Diagnostic performance of dedicated axillary T2- and diffusion-weighted MR imaging for nodal staging in breast cancer. Radiology. 2015;275(2):345–55.CrossRefPubMed
24.
Yamaguchi K, Schacht D, Nakazono T, Irie H, Abe H. Diffusion weighted images of metastatic as compared with nonmetastatic axillary lymph nodes in patients with newly diagnosed breast cancer[J]. Journal of Magnetic Resonance Imaging. 2015;42(3):771–778.
25.
Razek AA, Lattif MA, Denewer A, Farouk O, Nada N. Assessment of axillary lymph nodes in patients with breast cancer with diffusion-weighted MR imaging in combination with routine and dynamic contrast MR imaging[J]. Breast Cancer, 2015: 1–8.
26.
Jaeschke R, Guyatt GH, Sackett DL. Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994;271(9):703–7.CrossRefPubMed
27.
Fagan TJ. Letter: nomogram for Bayes theorem. N Engl J Med. 1975;293(5):257.PubMed
28.
29.
Junping W, Tongguo S, Yunting Z, Chunshui Y, Renju B. Discrimination of axillary metastatic from nonmetastatic lymph nodes with PROPELLER diffusion-weighted MR imaging in a metastatic breast cancer model and its correlation with cellularity. J Magn Reson Imaging. 2012;36(3):624–31.CrossRefPubMed
30.
Xue HD, Li S, Sun F, Sun HY, Jin ZY, Yang JX, Yu M. Clinical application of body diffusion weighted MR imaging in the diagnosis and preoperative N staging of cervical cancer. Chin Med Sci J. 2008;23(3):133–7.CrossRefPubMed
31.
Roy C, Bierry G, Matau A, Bazille G, Pasquali R. Value of diffusion-weighted imaging to detect small malignant pelvic lymph nodes at 3T. Eur Radiol. 2010;20(8):1803–11.CrossRefPubMed
32.
Cho EY, Kim SH, Yoon JH, Lee Y, Lim YJ, Kim SJ, Baek HJ, Eun CK. Apparent diffusion coefficient for discriminating metastatic from non-metastatic lymph nodes in primary rectal cancer. Eur J Radiol. 2013;82(11):e662–8.CrossRefPubMed
33.
Sumi M, Van Cauteren M, Nakamura T. MR microimaging of benign and malignant nodes in the neck. AJR Am J Roentgenol. 2006;186(3):749–57.CrossRefPubMed
34.
Yasui O, Sato M, Kamada A. Diffusion-weighted imaging in the detection of lymph node metastasis in colorectal cancer. Tohoku J Exp Med. 2009;218(3):177–83.CrossRefPubMed
35.
Lin G, Ho KC, Wang JJ, Ng KK, Wai YY, Chen YT, Chang CJ, Ng SH, Lai CH, Yen TC. Detection of lymph node metastasis in cervical and uterine cancers by diffusion-weighted magnetic resonance imaging at 3T. J Magn Reson Imaging. 2008;28(1):128–35.CrossRefPubMed
36.
Abdel RA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 2006;16(7):1468–77.CrossRef
37.
Bastin ME. Correction of eddy current-induced artefacts in diffusion tensor imaging using iterative cross-correlation. Magn Reson Imaging. 1999;17:1011–24.CrossRefPubMed
Metadata
Title
The Diagnosis of Metastatic Axillary Lymph Nodes of Breast Cancer By Diffusion Weighted Imaging: a meta-analysis and systematic review
Authors
Wei Fan Sui
Xiang Chen
Zhen Kun Peng
Jing Ye
Jing Tao Wu
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2016
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-016-0906-5

Other articles of this Issue 1/2016

World Journal of Surgical Oncology 1/2016 Go to the issue

Erratum

Erratum to: Surgical spacer placement prior carbon ion radiotherapy (CIRT): an effective feasible strategy to improve the treatment for sacral chordoma

Case report

Simultaneous reconstruction of the bone and vessels for complex femoral defect

Research

The importance of the lepidic component as a prognostic factor in stage I pulmonary adenocarcinoma

Research

Pulmonary metastasectomy in pediatric patients

Research

Lymph node ratio as a prognostic factor in patients with pathological N2 non-small cell lung cancer

Review

The SphKs/S1P/S1PR1 axis in immunity and cancer: more ore to be mined