Factors affecting the value of diffusion-weighted imaging for identifying breast cancer patients with pathological complete response on neoadjuvant systemic therapy: a systematic review

van der Hoogt, Kay J. J.; Schipper, Robert J.; Winter-Warnars, Gonneke A.; ter Beek, Leon C.; Loo, Claudette E.; Mann, Ritse M.; Beets-Tan, Regina G. H.

doi:10.1186/s13244-021-01123-1

Insights into Imaging

Table 5 Main region-of-interest specifications

From: Factors affecting the value of diffusion-weighted imaging for identifying breast cancer patients with pathological complete response on neoadjuvant systemic therapy: a systematic review

First author	2D/3D	Nr. (one/multiple)¹	Predefined absolute size?	Excluding areas²	Only highest signal (b-image)/lowest on ADC map/solid part tumor³	ROI no residual disease post-NST visible
Santamaria [27]⁴	2D: circular	Three (diff. sections)	Y: (≤ 15 mm²)	Y	Not specified	Pretreatment location
Tozaki [40]	2D: circular	One	Y 19.6 mm² (r = 2.5 mm)	n.r.	Y	n.r.
Bufi [17]
– Before	2D	One	No	Y	No	N/A
– Post⁵	–	–	–	–	–
Che [19]	2D	One	No: based on max transverse diameter	Y	Different description	n.r.
Fangberget [65]	Not spec.	One (solid part)	No	Y	Y	n.r.
Minarikova [59]⁶	3D	One	No: region growing (upper & lower bounds)	Not specified (in 3D)	No	n.r.
Woodhams [64]⁷	2D	Pre: two to seven	No	Not specified	No	n.r.
Woodhams [64]⁷	2D	Post: one to seven	No	Not specified	No	n.r.
Shin [26]	3D	One	No	Y	No	No residual enhancement: images compared pre and post-NAC, incl. cardiac level and the surrounding
Hahn [67]	2D	Three (slices)	No (based on the largest cross-sectional planes → three slides)	Y (especially fat and normal parenchyma, further not specified)	No	n.r.
Yuan [22]	3D	One	No	Y	No	n.r.
Partridge [23]	3D	One composite	No	Y	No	Region at previous scan with visible tumor
Gallivanone [21]	3D	One	No (semi-automatic method: see Gallivanone et al.)	Y	Not only (see details Gallivanone et al.)	n.r.
Li [44]	3D	One	No (copied from the DCE-ROI tumor⁸)	n.r.	Different description	n.r.
Fujimoto [66]	2D	One	No (based on largest diameter)	Y	Different description	Pre-treatment ROI
Liu [16]	2D (pseudo- 3D)	Three	No (based on largest cross-sectional area’s)	n.r.	Different description	Pre-treatment ROI
Bedair [20]	2D	One	No	Y	No: largest tumor dimension on b = 900	n.r.
Ramirez-Galván [25]	2D	Three	No (three ellipses randomly placed)	Y	No	?
Pereira [18]	2D	One	n.r.	Y	Y	n.r.
Zhang [24]	2D	Three types:	n.r.	Y	Different description	n.r.
		(a) Freehand
		(b) Single-round
		(c) Three-round
Kim [53]	2D (manual) → 3D (automatic)	Three (sagittal, coronal, axial)	No	Y	Different (on b = 0, based on DCE and T2)	n.r.

ADC apparent diffusion coefficient, n.r. not reported, r radius, ROI region of interest
¹Short description
²Not specified for which areas (but referring to areas such as inner margins, necrotic, fibrotic areas etc.)
³No: the ROI was not limited to solid or other tumor part on the slice or high signal on b-image, respectively, low signal on ADC
⁴Multiple ROI methods, but this refers to mean value method used for data analysis, the reported area could be for all three together or each area
⁵Situation depended: delineation on b = 1000 s/mm², in case of tumor fragmentation ROI including not hyperintense “interspersed” area and the whole lesion, otherwise in case of no clear region, ROI of 100 pixels within the previous observed area
⁶2D and 3D ROI’s: 3D-ROI’s in majority used for comparisons-not applicable: referring to a different image property
⁷The ADC of the multiple ROI’s were averaged and mean ROI-size was pre-NST 37 ± 17 mm and post-NST 20 ± 15 mm
⁸At least 80% percent signal intensity increase after contrast injection, see further Li et al. [44] Pseudo 3D: several slices, but not whole lesion in 3D

Back to article page