Investig Magn Reson Imaging.  2015 Mar;19(1):37-46. 10.13104/imri.2015.19.1.37.

Diagnostic Effectiveness of USPIO versus Gadolinium Based MRI for Axillary Metastasis in Breast Cancer: A Meta-analysis

• Kim Y
• Jae E
• Park J

• KMID: 2175575
• DOI: http://doi.org/10.13104/imri.2015.19.1.37

Abstract

PURPOSE
This report compared the diagnostic effectiveness between ultrasmall superparamagnetic iron oxide (USPIO) and gadolinium (Gd) based magnetic resonance imaging (MRI) for differentiation of axillary status in breast cancer patients.
MATERIALS AND METHODS
The present authors performed a meta-analysis of previous studies that compared USPIO or Gd based MRI with histological diagnosis after surgery or biopsy. We searched PubMed, EMBASE, Cochrane Library, ScienceDirect, SpringerLink, Ovid databases and references of articles to identify studies reporting data until December 2013. Pooled sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analysis was done. Analyses of study quality and heterogeneity were also assessed.
RESULTS
There were 14 publications that met the criteria for inclusion in our metaanalysis. USPIO based MRI showed 0.83 (95% CI: 0.75-0.89) and 0.97 (95% CI: 0.94-0.98) for pooled sensitivity and specificity, respectively. Gd based MRI represented pooled sensitivity and specificity of 0.61 (95% CI: 0.55-0.67) and 0.90 (95% CI: 0.87-0.92) for each. Overall weighted area under the curve for USPIO and Gd based MRI were 0.9563 and 0.9051, respectively.
CONCLUSION
USPIO based MRI had a tendency toward high pooled sensitivity and specificity in detection of axillary metastases for breast cancer. This result may mean that USPIO based MRI could be used as complementary modality to differentiate axillary status more precisely, and assist in the decision-making process regarding possible invasive procedures, such as sentinel node biopsy.

Keyword

Breast neoplasm; Lymphatic metastasis; Magnetic resonance imaging; Nanoparticles

MeSH Terms

Biopsy
Breast Neoplasms*
Diagnosis
Gadolinium*
Humans
Iron
Lymphatic Metastasis
Magnetic Resonance Imaging*
Nanoparticles
Neoplasm Metastasis*
Population Characteristics
ROC Curve
Sensitivity and Specificity
Gadolinium
Iron

Figure

• 

  Fig. 1 Flow chart of this meta-analysis. CI = confidence interval; Gd = gadolinium; MRI = magnetic resonance imaging; USPIO = ultrasmall superparamagnetic iron oxide

• 

  Fig. 2 Forest plots of all studies. Sensitivity and specificity of (a) overall MRI, (b) USPIO and (c) Gd based MRI. CI = confidence interval; Gd = gadolinium; MRI = magnetic resonance imaging; USPIO = ultrasmall superparamagnetic iron oxide

• 

  Fig. 3 Summary receiver operating characteristics curves of (a) overall MRI, (b) USPIO and (c) Gd based MRI. AUC = area under curve; Gd = gadolinium; MRI = magnetic resonance imaging; SE = standard error; SROC = summary receiver operating characteristic; USPIO = ultrasmall superparamagnetic iron oxide

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