title: Meta analysis of lymph node metastasis of breast cancer patients: Clinical value of DWI and ADC value.
abstract: OBJECTIVE
  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.
  
  
  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 800s/mm(2) 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 800s/mm(2) are recommended.
authors.affiliation: Breast Surgery Department, China-Japan Union Hospital Of Jilin University, Xian Tai street number 126, Changchun, Jilin Province 130033, PR China.
authors.forename: Hua
authors.initials: H
authors.lastname: Xing
authors.affiliation: Breast Surgery Department, China-Japan Union Hospital Of Jilin University, Xian Tai street number 126, Changchun, Jilin Province 130033, PR China. Electronic address: scl151@vip.sina.com.
authors.forename: Chang-Long
authors.initials: CL
authors.lastname: Song
authors.affiliation: Breast Surgery Department, China-Japan Union Hospital Of Jilin University, Xian Tai street number 126, Changchun, Jilin Province 130033, PR China.
authors.forename: Wen-Jia
authors.initials: WJ
authors.lastname: Li
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Apparent diffusion coefficient; Diffusion weighted imaging; Lymph node metastases; Meta-analysis