title: Differential diagnosis between malignant and benign breast lesions using single-voxel proton MRS: a meta-analysis.
abstract: OBJECTIVE
  We aim to investigate the diagnostic capability of single-voxel proton MR spectroscopy (MRS) for benign/malignant discrimination of focal breast lesions with a meta-analysis.
  
  
  METHODS
  The meta-analysis included a total of 750 malignant breast lesions and 419 benign breast lesions from eighteen studies.
  
  
  RESULTS
  The pooled sensitivity and specificity of MRS were 0.71 (95 % CI 0.68-0.74) and 0.85 (95 % CI 0.81-0.88), respectively. The positive likelihood ratio and negative LR were 4.11 (95 % CI 3.11-5.43) and 0.25 (95 % CI 0.17-0.36), respectively. The P value for χ(2) heterogeneity for all pooled estimates was <0.05. From the fitted summary receiver operating characteristics curve, AUC was 0.89 and Q* was 0.84. Asymmetrical in funnel plots indicated there may be publication bias (t = 2.85, P = 0.012). The meta-regression analysis indicated that neither threshold effect nor evaluated covariates that include strength of field, scanning technique (PRESS or STEAM), repetition time, NSA, and pre- or post-contrast agent were the sources of heterogeneity (all P value >0.05).
  
  
  CONCLUSIONS
  Single-voxel proton MRS was useful for differentiation between malignant and benign breast lesions. However, pooled diagnostic measures might be overestimated. The standardization of the acquisition protocol for MRS across the multicenter trials is recommended.
authors.affiliation: Department of Oncology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, Guangdong Province, People's Republic of China.
authors.forename: Dongzhi
authors.initials: D
authors.lastname: Cen
authors.forename: Li
authors.initials: L
authors.lastname: Xu
mesh_terms: D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D011230:Precancerous Conditions / Q000175:diagnosis*; D011379:Prognosis; D011522:Protons
chemical_list: D011522:Protons