Diagnostic Effectiveness of USPIO versus Gadolinium Based MRI for Axillary Metastasis in Breast Cancer: A Meta-analysis
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Purpose: This report compared the diagnostic effectiveness between ultrasmallsuperparamagnetic iron oxide (USPIO) and gadolinium (Gd) based magnetic resonanceimaging (MRI) for differentiation of axillary status in breast cancer patients. Materials and Methods: The present authors performed a meta-analysis of previousstudies that compared USPIO or Gd based MRI with histological diagnosis aftersurgery or biopsy. We searched PubMed, EMBASE, Cochrane Library, ScienceDirect,SpringerLink, Ovid databases and references of articles to identify studies reportingdata until December 2013. Pooled sensitivity and specificity were calculated for everystudy; 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 representedpooled 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 MRIwere 0.9563 and 0.9051, respectively. Conclusion: USPIO based MRI had a tendency toward high pooled sensitivity andspecificity in detection of axillary metastases for breast cancer. This result may meanthat USPIO based MRI could be used as complementary modality to differentiateaxillary status more precisely, and assist in the decision-making process regardingpossible invasive procedures, such as sentinel node biopsy.
Abstract
Purpose: This report compared the diagnostic effectiveness between ultrasmallsuperparamagnetic iron oxide (USPIO) and gadolinium (Gd) based magnetic resonanceimaging (MRI) for differentiation of axillary status in breast cancer patients. Materials and Methods: The present authors performed a meta-analysis of previousstudies that compared USPIO or Gd based MRI with histological diagnosis aftersurgery or biopsy. We searched PubMed, EMBASE, Cochrane Library, ScienceDirect,SpringerLink, Ovid databases and references of articles to identify studies reportingdata until December 2013. Pooled sensitivity and specificity were calculated for everystudy; 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 representedpooled 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 MRIwere 0.9563 and 0.9051, respectively. Conclusion: USPIO based MRI had a tendency toward high pooled sensitivity andspecificity in detection of axillary metastases for breast cancer. This result may meanthat USPIO based MRI could be used as complementary modality to differentiateaxillary status more precisely, and assist in the decision-making process regardingpossible invasive procedures, such as sentinel node biopsy.
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