Journal Article

Diagnostic performance of breast tumor tissue selection in diffusion weighted imaging: A systematic review and meta-analysis

Dorrius, M. D., Wielema, M., Baltzer, P. A. T., Oudkerk, M., De Bock, G. H., Pijnappel, R. M., Sijens, P. E.

2020

Overview

Several methods for tumor delineation are used in literature on breast diffusion weighted imaging (DWI) to measure the apparent diffusion coefficient (ADC). However, in the process of reaching consensus on breast DWI scanning protocol, image analysis and interpretation, still no standardized optimal breast tumor tissue selection (BTTS) method exists. Therefore, the purpose of this study is to assess the impact of BTTS methods on ADC in the discrimination of benign from malignant breast lesions in DWI in terms of sensitivity, specificity and area under the curve (AUC). In this systematic review and meta-analysis, adhering to the PRISMA statement, 61 studies, with 65 study subsets, in females with benign or malignant primary breast lesions (6291 lesions) were assessed. Studies on DWI, quantified by ADC, scanned on 1.5 and 3.0 Tesla and using b-values 0/50 and ≥ 800 s/mm2 were included. PubMed and EMBASE were searched for studies up to 23-10-2019 (n = 2897). Data were pooled based on four BTTS methods (by definition of measured region of interest, ROI): BTTS1: whole breast tumor tissue selection, BTTS2: subtracted whole breast tumor tissue selection, BTTS3: circular breast tumor tissue selection and BTTS4: lowest diffusion breast tumor tissue selection. BTTS methods 2 and 3 excluded necrotic, cystic and hemorrhagic areas. Pooled sensitivity, specificity and AUC of the BTTS methods were calculated. Heterogeneity was explored using the inconsistency index (I2) and considering covariables: field strength, lowest b-value, image of BTTS selection, pre-or post-contrast DWI, slice thickness and ADC threshold. Pooled sensitivity, specificity and AUC were: 0.82 (0.72-0.89), 0.79 (0.65-0.89), 0.88 (0.85-0.90) for BTTS1; 0.91 (0.89-0.93), 0.84 (0.80-0.87), 0.94 (0.91-0.96) for BTTS2; 0.89 (0.86-0.92), 0.90 (0.85-0.93), 0.95 (0.93-0.96) for BTTS3 and 0.90 (0.86-0.93), 0.84 (0.81-0.87), 0.86 (0.82-0.88) for BTTS4, respectively. Significant heterogeneity was found between studies (I2 = 95). None of the breast tissue selection (BTTS) methodologies outperformed in differentiating benign from malignant breast lesions. The high heterogeneity of ADC data acquisition demands further standardization, such as DWI acquisition parameters and tumor tissue selection to substantially increase the reliability of DWI of the breast.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Accuracy / Adult / Aged / Area Under Curve / Benign / Bias / Biology and Life Sciences / Breast / Breast cancer / Breast Diseases - diagnostic imaging / Breast Neoplasms - diagnostic imaging / Breast Neoplasms - pathology / Breast tumors / Data acquisition / Data collection / Diagnosis / Diagnosis, Differential / Diagnostic imaging / Diagnostic systems / Diffusion / Diffusion coefficient / Diffusion Magnetic Resonance Imaging - methods / Driving while intoxicated / Evaluation / Female / Fibrocystic Breast Disease - diagnostic imaging / Field strength / Hemorrhage / Hemorrhage - diagnostic imaging / Heterogeneity / Humans / Image analysis / Image contrast / Image Interpretation, Computer-Assisted - methods / Image processing / Influence / Lesions / Magnetic resonance imaging / Mathematical analysis / Measurement methods / Medical diagnosis / Medicine and Health Sciences / Meta-analysis / Methods / Middle Aged / Necrosis / Optical scanners / Physical Sciences / Predictive Value of Tests / Regression analysis / Reproducibility of Results / Research and Analysis Methods / ROC Curve / Sensitivity / Sensitivity and Specificity / Standardization / Studies / Systematic review / Tissues / Tumors