Meta analysis of lymph node metastasis of breast cancer patients: Clinical value of DWI and ADC value

Objectives: To evaluate the diagnostic utility of DWI in the assessment of node metastases and investigate whether the ADC value could be used to discriminate between metastatic and non-metastatic lymph nodes in breast cancer patients. Materials and methods: 13 studies with a total of 676 metastatic and 811 non-metastatic lymph nodes were included. Results: (1) The pooled sensitivity, specificity, PPV and NPV of DWI were 0.83, 0.82, 0.83 and 0.85, respectively. The PLR and NLR were 4.95 and 0.23, respectively. The AUC and Q* index were 0.91 and 0.85, respectively. (2) The ADC value of metastatic lymph nodes was lower than non-metastatic lymph nodes (WMD= 0.213, 95% CI 0.349 to 0.076, Z = 3.05, P<0.05). (3) Subgroup meta-analysis of the group of b(0800): The pooled sensitivity, specificity, PPV and NPV of DWI were 0.86, 0.86, 0.82 and 0.90, respectively. The PLR and NLR were 6.76 and 0.18, respectively. The AUC and Q* index were 0.93 and 0.87. The ADC value of metastatic lymph nodes was lower than non-metastatic lymph nodes( WMD = 0.267, 95% CI 0.348 to 0.185, Z= 6.40, P<0.05). Conclusions: DWI and ADC value appear to be a reliable method to differentiate metastatic and non metastatic lymph nodes. The combination of b =0 and 800 sImm2 resulted in higher diagnostic accuracy and more pronounced ADC value difference. If only a couple of b values are used, those of b =0 and 800 s/mm(2) are recommended. (C) 2016 Elsevier Ireland Ltd. All rights reserved.