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Differential diagnosis between metastatic and non-metastatic lymph nodes using DW-MRI: a meta-analysis of diagnostic accuracy studies

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purposes

The purpose of our meta-analysis was to assess the overall diagnostic value of diffusion-weighted magnetic resonance imaging (DW-MRI) in detecting node metastases and investigate whether the apparent diffusion coefficient (ADC) value could be used to discriminate between metastatic and non-metastatic lymph nodes in patients with primary tumors.

Materials and methods

The meta-analysis included a total of 1,748 metastatic and 6,547 non-metastatic lymph nodes from 39 studies, including 8 different tumor types with lymph node metastases.

Results

The pooled sensitivity and specificity of DW-MRI were 0.82 (95 % CI 0.76–0.87) and 0.92 (95 % CI 0.88–0.94), respectively. The positive likelihood ratio (PLR), negative likelihood ratio (NLR), and the area under the curve were 9.8 (95 % CI 6.9–14.0), 0.20 (95 % CI 0.15–0.26) and 0.93 (95 % CI 0.91–0.95), respectively. The probability of 42 % can be viewed as the cutoff pretest probability for DW-MRI to diagnosis lymph node metastases; when the more chance of metastatic increased from 42 % that the pretest probability was estimated, it was more suitable to emphasize on “ruling in,” on the contrary, and when the more chance of metastatic decreased from 42 %, it was more suitable to emphasize on “ruling out.” Furthermore, the mean ADC value of metastatic lymph nodes was significantly lower than that of non-metastatic (P = 0.001).

Conclusions

DW-MRI is useful for differentiation between metastatic and non-metastatic lymph nodes. However, DW-MRI has a moderate diagnostic value for physician’s decision making when PLR and NLR took into consideration, while a superior ability for nodal metastases confirmation, but an inferior ability for ruling out. In the future, large-scale, high-quality trials are necessary to evaluate, respectively, their clinical value in different tumor types with nodal metastases.

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We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work. No conflict of interest or disclaimers exists for any author.

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Authors and Affiliations

  1. Department of General Surgery, Chaohu Hospital of Anhui Medical University, No. 64 Chaohu Bei Road, Chaohu, Hefei, 238000, China

    Min Zhou, Bin Lu, Gang Lv, Qin Tang, Jibiao Zhu, Jun Li & Kaide Shi

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  1. Min Zhou
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  2. Bin Lu
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  3. Gang Lv
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Correspondence to Min Zhou.

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Min Zhou and Bin Lu have contributed equally to this work.

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Zhou, M., Lu, B., Lv, G. et al. Differential diagnosis between metastatic and non-metastatic lymph nodes using DW-MRI: a meta-analysis of diagnostic accuracy studies. J Cancer Res Clin Oncol 141, 1119–1130 (2015). https://doi.org/10.1007/s00432-014-1895-9

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  • DOI: https://doi.org/10.1007/s00432-014-1895-9

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