Skip to main content
Erschienen in: Journal of Cancer Research and Clinical Oncology 6/2014

01.06.2014 | Original Article - Clinical Oncology

Differential diagnosis between malignant and benign breast lesions using single-voxel proton MRS: a meta-analysis

verfasst von: Dongzhi Cen, Li Xu

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 6/2014

Einloggen, um Zugang zu erhalten

Abstract

Objectives

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.

Materials and 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.
Literatur
Zurück zum Zitat Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, Carlson RW, Azavedo E, Harford J (2008) Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer 113:2221–2243PubMedCrossRef Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, Carlson RW, Azavedo E, Harford J (2008) Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer 113:2221–2243PubMedCrossRef
Zurück zum Zitat Baek HM (2012) Diagnostic value of breast proton magnetic resonance spectroscopy at 1.5 T in different histopathological types. Sci World J 2012:508295CrossRef Baek HM (2012) Diagnostic value of breast proton magnetic resonance spectroscopy at 1.5 T in different histopathological types. Sci World J 2012:508295CrossRef
Zurück zum Zitat Baek HM, Chen JH, Yu HJ, Mehta R, Nalcioglu O, Su MY (2008) Detection of choline signal in human breast lesions with chemical-shift imaging. J Magn Reson Imaging 27:1114–1121PubMedCrossRef Baek HM, Chen JH, Yu HJ, Mehta R, Nalcioglu O, Su MY (2008) Detection of choline signal in human breast lesions with chemical-shift imaging. J Magn Reson Imaging 27:1114–1121PubMedCrossRef
Zurück zum Zitat Baltzer PA, Dietzel M, Kaiser WA (2012) MR-spectroscopy at 1.5 tesla and 3 tesla. Useful? A systematic review and meta-analysis. Eur J Radiol 81(Suppl 1):S6–S9PubMedCrossRef Baltzer PA, Dietzel M, Kaiser WA (2012) MR-spectroscopy at 1.5 tesla and 3 tesla. Useful? A systematic review and meta-analysis. Eur J Radiol 81(Suppl 1):S6–S9PubMedCrossRef
Zurück zum Zitat Bartella L, Huang W (2007) Proton (1H) MR spectroscopy of the breast. Radiographics: a review publication of the Radiological Society of North America, Inc, 27 Suppl 1:S241–S252 Bartella L, Huang W (2007) Proton (1H) MR spectroscopy of the breast. Radiographics: a review publication of the Radiological Society of North America, Inc, 27 Suppl 1:S241–S252
Zurück zum Zitat Bartella L, Morris EA (2006) Advances in breast imaging: magnetic resonance imaging. Curr Oncol Rep 8:7–13PubMedCrossRef Bartella L, Morris EA (2006) Advances in breast imaging: magnetic resonance imaging. Curr Oncol Rep 8:7–13PubMedCrossRef
Zurück zum Zitat Bartella L, Morris EA, Dershaw DD, Liberman L, Thakur SB, Moskowitz C, Guido J, Huang W (2006) Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: preliminary study. Radiology 239:686–692PubMedCrossRef Bartella L, Morris EA, Dershaw DD, Liberman L, Thakur SB, Moskowitz C, Guido J, Huang W (2006) Proton MR spectroscopy with choline peak as malignancy marker improves positive predictive value for breast cancer diagnosis: preliminary study. Radiology 239:686–692PubMedCrossRef
Zurück zum Zitat Bartella L, Smith CS, Dershaw DD, Liberman L (2007) Imaging breast cancer. Radiol Clin North Am 45:45–67PubMedCrossRef Bartella L, Smith CS, Dershaw DD, Liberman L (2007) Imaging breast cancer. Radiol Clin North Am 45:45–67PubMedCrossRef
Zurück zum Zitat Basara I, Orguc S, Coskun T (2013) Single voxel in vivo proton magnetic resonance spectroscopy of breast lesions: experience in 77 cases. Diagn Interv Radiol 19:221–226PubMed Basara I, Orguc S, Coskun T (2013) Single voxel in vivo proton magnetic resonance spectroscopy of breast lesions: experience in 77 cases. Diagn Interv Radiol 19:221–226PubMed
Zurück zum Zitat Cecil KM, Schnall MD, Siegelman ES, Lenkinski RE (2001) The evaluation of human breast lesions with magnetic resonance imaging and proton magnetic resonance spectroscopy. Breast Cancer Res Treat 68:45–54PubMedCrossRef Cecil KM, Schnall MD, Siegelman ES, Lenkinski RE (2001) The evaluation of human breast lesions with magnetic resonance imaging and proton magnetic resonance spectroscopy. Breast Cancer Res Treat 68:45–54PubMedCrossRef
Zurück zum Zitat Coleman MP, Quaresma M, Berrino F, Lutz JM, De Angelis R, Capocaccia R, Baili P, Rachet B, Gatta G, Hakulinen T, Micheli A, Sant M, Weir HK, Elwood JM, Tsukuma H, Koifman S, GA ES, Francisci S, Santaquilani M, Verdecchia A, Storm HH, Young JL, Group CW (2008) Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 9:730–756PubMedCrossRef Coleman MP, Quaresma M, Berrino F, Lutz JM, De Angelis R, Capocaccia R, Baili P, Rachet B, Gatta G, Hakulinen T, Micheli A, Sant M, Weir HK, Elwood JM, Tsukuma H, Koifman S, GA ES, Francisci S, Santaquilani M, Verdecchia A, Storm HH, Young JL, Group CW (2008) Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 9:730–756PubMedCrossRef
Zurück zum Zitat Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M, Comparative Risk Assessment collaborating group (2005) Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet 366:1784–1793PubMedCrossRef Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M, Comparative Risk Assessment collaborating group (2005) Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet 366:1784–1793PubMedCrossRef
Zurück zum Zitat El Khouli RH, Macura KJ, Jacobs MA, Khalil TH, Kamel IR, Dwyer A, Bluemke DA (2009) Dynamic contrast-enhanced MRI of the breast: quantitative method for kinetic curve type assessment. AJR Am J Roentgenol 193:W295–W300PubMedCentralPubMedCrossRef El Khouli RH, Macura KJ, Jacobs MA, Khalil TH, Kamel IR, Dwyer A, Bluemke DA (2009) Dynamic contrast-enhanced MRI of the breast: quantitative method for kinetic curve type assessment. AJR Am J Roentgenol 193:W295–W300PubMedCentralPubMedCrossRef
Zurück zum Zitat Ho KM (2007) Forest and funnel plots illustrated the calibration of a prognostic model: a descriptive study. J Clin Epidemiol 60:746–751PubMedCrossRef Ho KM (2007) Forest and funnel plots illustrated the calibration of a prognostic model: a descriptive study. J Clin Epidemiol 60:746–751PubMedCrossRef
Zurück zum Zitat Huang W, Fisher PR, Dulaimy K, Tudorica LA, O’Hea B, Button TM (2004) Detection of breast malignancy: diagnostic MR protocol for improved specificity. Radiology 232:585–591PubMedCrossRef Huang W, Fisher PR, Dulaimy K, Tudorica LA, O’Hea B, Button TM (2004) Detection of breast malignancy: diagnostic MR protocol for improved specificity. Radiology 232:585–591PubMedCrossRef
Zurück zum Zitat Jagannathan NR, Kumar M, Seenu V, Coshic O, Dwivedi SN, Julka PK, Srivastava A, Rath GK (2001) Evaluation of total choline from in vivo volume localized proton MR spectroscopy and its response to neoadjuvant chemotherapy in locally advanced breast cancer. Br J Cancer 84:1016–1022PubMedCentralPubMedCrossRef Jagannathan NR, Kumar M, Seenu V, Coshic O, Dwivedi SN, Julka PK, Srivastava A, Rath GK (2001) Evaluation of total choline from in vivo volume localized proton MR spectroscopy and its response to neoadjuvant chemotherapy in locally advanced breast cancer. Br J Cancer 84:1016–1022PubMedCentralPubMedCrossRef
Zurück zum Zitat Kim JK, Park SH, Lee HM, Lee YH, Sung NK, Chung DS, Kim OD (2003) In vivo 1H-MRS evaluation of malignant and benign breast diseases. Breast 12:179–182PubMedCrossRef Kim JK, Park SH, Lee HM, Lee YH, Sung NK, Chung DS, Kim OD (2003) In vivo 1H-MRS evaluation of malignant and benign breast diseases. Breast 12:179–182PubMedCrossRef
Zurück zum Zitat Kousi E, Tsougos I, Vasiou K, Theodorou K, Poultsidi A, Fezoulidis I, Kappas C (2012) Magnetic resonance spectroscopy of the breast at 3T: pre- and post-contrast evaluation for breast lesion characterization. Sci World J 2012:754380 Kousi E, Tsougos I, Vasiou K, Theodorou K, Poultsidi A, Fezoulidis I, Kappas C (2012) Magnetic resonance spectroscopy of the breast at 3T: pre- and post-contrast evaluation for breast lesion characterization. Sci World J 2012:754380
Zurück zum Zitat Kvistad KA, Bakken IJ, Gribbestad IS, Ehrnholm B, Lundgren S, Fjosne HE, Haraldseth O (1999) Characterization of neoplastic and normal human breast tissues with in vivo (1)H MR spectroscopy. J Magn Reson Imaging 10:159–164PubMedCrossRef Kvistad KA, Bakken IJ, Gribbestad IS, Ehrnholm B, Lundgren S, Fjosne HE, Haraldseth O (1999) Characterization of neoplastic and normal human breast tissues with in vivo (1)H MR spectroscopy. J Magn Reson Imaging 10:159–164PubMedCrossRef
Zurück zum Zitat Kwee SA, DeGrado TR, Talbot JN, Gutman F, Coel MN (2007) Cancer imaging with fluorine-18-labeled choline derivatives. Semin Nucl Med 37:420–428PubMedCrossRef Kwee SA, DeGrado TR, Talbot JN, Gutman F, Coel MN (2007) Cancer imaging with fluorine-18-labeled choline derivatives. Semin Nucl Med 37:420–428PubMedCrossRef
Zurück zum Zitat Lacey JV, Kreimer AR, Buys SS, Marcus PM, Chang SC, Leitzmann MF, Hoover RN, Prorok PC, Berg CD, Hartge P, Prostate LC, Ovarian Cancer Screening Trial Project T (2009) Breast cancer epidemiology according to recognized breast cancer risk factors in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial cohort. BMC Cancer 9:84PubMedCentralPubMedCrossRef Lacey JV, Kreimer AR, Buys SS, Marcus PM, Chang SC, Leitzmann MF, Hoover RN, Prorok PC, Berg CD, Hartge P, Prostate LC, Ovarian Cancer Screening Trial Project T (2009) Breast cancer epidemiology according to recognized breast cancer risk factors in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial cohort. BMC Cancer 9:84PubMedCentralPubMedCrossRef
Zurück zum Zitat Li Y, Chen Z, Wang J (2012) Differential diagnosis between malignant and benign hepatic tumors using apparent diffusion coefficient on 1.5-T MR imaging: a meta analysis. Eur J Radiol 81:484–490PubMedCrossRef Li Y, Chen Z, Wang J (2012) Differential diagnosis between malignant and benign hepatic tumors using apparent diffusion coefficient on 1.5-T MR imaging: a meta analysis. Eur J Radiol 81:484–490PubMedCrossRef
Zurück zum Zitat Lu H, Liu PF, Bao RX, Sun F (2006) Evaluation of spectral selected press sequence in breast lesion characterization. Chin Med Sci J = Chung-kuo i hsueh k’o hsueh tsa chih/Chin Acad Med Sci 21:265–269 Lu H, Liu PF, Bao RX, Sun F (2006) Evaluation of spectral selected press sequence in breast lesion characterization. Chin Med Sci J = Chung-kuo i hsueh k’o hsueh tsa chih/Chin Acad Med Sci 21:265–269
Zurück zum Zitat Mizukoshi W, Kozawa E, Inoue K, Saito N, Nishi N, Saeki T, Kimura F (2013) (1)H MR spectroscopy with external reference solution at 1.5 T for differentiating malignant and benign breast lesions: comparison using qualitative and quantitative approaches. Eur Radiol 23:75–83PubMedCrossRef Mizukoshi W, Kozawa E, Inoue K, Saito N, Nishi N, Saeki T, Kimura F (2013) (1)H MR spectroscopy with external reference solution at 1.5 T for differentiating malignant and benign breast lesions: comparison using qualitative and quantitative approaches. Eur Radiol 23:75–83PubMedCrossRef
Zurück zum Zitat Mountford C, Ramadan S, Stanwell P, Malycha P (2009) Proton MRS of the breast in the clinical setting. NMR Biomed 22:54–64PubMedCrossRef Mountford C, Ramadan S, Stanwell P, Malycha P (2009) Proton MRS of the breast in the clinical setting. NMR Biomed 22:54–64PubMedCrossRef
Zurück zum Zitat Nelson MT, Everson LI, Garwood M, Emory T, Bolan PJ (2008) MR spectroscopy in the diagnosis and treatment of breast cancer. Semin Breast Dis 11:100–105PubMedCentralPubMedCrossRef Nelson MT, Everson LI, Garwood M, Emory T, Bolan PJ (2008) MR spectroscopy in the diagnosis and treatment of breast cancer. Semin Breast Dis 11:100–105PubMedCentralPubMedCrossRef
Zurück zum Zitat Roebuck JR, Cecil KM, Schnall MD, Lenkinski RE (1998) Human breast lesions: characterization with proton MR spectroscopy. Radiology 209:269–275PubMed Roebuck JR, Cecil KM, Schnall MD, Lenkinski RE (1998) Human breast lesions: characterization with proton MR spectroscopy. Radiology 209:269–275PubMed
Zurück zum Zitat Sardanelli F, Fausto A, Di Leo G, de Nijs R, Vorbuchner M, Podo F (2009) In vivo proton MR spectroscopy of the breast using the total choline peak integral as a marker of malignancy. AJR Am J Roentgenol 192:1608–1617PubMedCrossRef Sardanelli F, Fausto A, Di Leo G, de Nijs R, Vorbuchner M, Podo F (2009) In vivo proton MR spectroscopy of the breast using the total choline peak integral as a marker of malignancy. AJR Am J Roentgenol 192:1608–1617PubMedCrossRef
Zurück zum Zitat Shah N, Sattar A, Benanti M, Hollander S, Cheuck L (2006) Magnetic resonance spectroscopy as an imaging tool for cancer: a review of the literature. J Am Osteopath Assoc 106:23–27PubMed Shah N, Sattar A, Benanti M, Hollander S, Cheuck L (2006) Magnetic resonance spectroscopy as an imaging tool for cancer: a review of the literature. J Am Osteopath Assoc 106:23–27PubMed
Zurück zum Zitat Souza JP, Pileggi C, Cecatti JG (2007) Assessment of funnel plot asymmetry and publication bias in reproductive health meta-analyses: an analytic survey. Reprod Health 4:3PubMedCentralPubMedCrossRef Souza JP, Pileggi C, Cecatti JG (2007) Assessment of funnel plot asymmetry and publication bias in reproductive health meta-analyses: an analytic survey. Reprod Health 4:3PubMedCentralPubMedCrossRef
Zurück zum Zitat Suppiah S, Rahmat K, Mohd-Shah MN, Azlan CA, Tan LK, Aziz YF, Vijayananthan A, Wui AL, Yip CH (2013) Improved diagnostic accuracy in differentiating malignant and benign lesions using single-voxel proton MRS of the breast at 3 T MRI. Clin Radiol 68:e502–e510PubMedCrossRef Suppiah S, Rahmat K, Mohd-Shah MN, Azlan CA, Tan LK, Aziz YF, Vijayananthan A, Wui AL, Yip CH (2013) Improved diagnostic accuracy in differentiating malignant and benign lesions using single-voxel proton MRS of the breast at 3 T MRI. Clin Radiol 68:e502–e510PubMedCrossRef
Zurück zum Zitat Tozaki M, Fukuma E (2009) 1H MR spectroscopy and diffusion-weighted imaging of the breast: are they useful tools for characterizing breast lesions before biopsy? AJR Am J Roentgenol 193:840–849PubMedCrossRef Tozaki M, Fukuma E (2009) 1H MR spectroscopy and diffusion-weighted imaging of the breast: are they useful tools for characterizing breast lesions before biopsy? AJR Am J Roentgenol 193:840–849PubMedCrossRef
Zurück zum Zitat Tse GM, Cheung HS, Pang LM, Chu WC, Law BK, Kung FY, Yeung DK (2003) Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions, and phyllodes tumors. AJR Am J Roentgenol 181:1267–1272PubMedCrossRef Tse GM, Cheung HS, Pang LM, Chu WC, Law BK, Kung FY, Yeung DK (2003) Characterization of lesions of the breast with proton MR spectroscopy: comparison of carcinomas, benign lesions, and phyllodes tumors. AJR Am J Roentgenol 181:1267–1272PubMedCrossRef
Zurück zum Zitat Vassiou K, Tsougos I, Kousi E, Vlychou M, Athanasiou E, Theodorou K, Arvanitis DL, Fezoulidis IV (2013) Application value of 3T 1H-magnetic resonance spectroscopy in diagnosing breast tumors. Acta Radiol 54:380–388CrossRef Vassiou K, Tsougos I, Kousi E, Vlychou M, Athanasiou E, Theodorou K, Arvanitis DL, Fezoulidis IV (2013) Application value of 3T 1H-magnetic resonance spectroscopy in diagnosing breast tumors. Acta Radiol 54:380–388CrossRef
Zurück zum Zitat Yeh J, D’Amico F (1007) Forest plots: data summaries at a glance. J Fam Pract 2004:53 Yeh J, D’Amico F (1007) Forest plots: data summaries at a glance. J Fam Pract 2004:53
Zurück zum Zitat Yeung DK, Cheung HS, Tse GM (2001) Human breast lesions: characterization with contrast-enhanced in vivo proton MR spectroscopy—initial results. Radiology 220:40–46PubMedCrossRef Yeung DK, Cheung HS, Tse GM (2001) Human breast lesions: characterization with contrast-enhanced in vivo proton MR spectroscopy—initial results. Radiology 220:40–46PubMedCrossRef
Metadaten
Titel
Differential diagnosis between malignant and benign breast lesions using single-voxel proton MRS: a meta-analysis
verfasst von
Dongzhi Cen
Li Xu
Publikationsdatum
01.06.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Journal of Cancer Research and Clinical Oncology / Ausgabe 6/2014
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-014-1605-7

Weitere Artikel der Ausgabe 6/2014

Journal of Cancer Research and Clinical Oncology 6/2014 Zur Ausgabe

Original Article – Clinical Oncology

Primary malignant cardiac tumors

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.