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 6 DWI parameters pre-NST

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	ADC-value (× 10⁻³ mm²/s) pCR versus non-pCR^a	Reported/chosen ADC threshold for pCR (× 10⁻³ mm²/s)	ROC AUC (95% CI)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
Minarikova [59]	0.87 ± 0.12 versus 0.96 ± 0.23 p = 0.287		0.633
Shin [26]	0.83 (0.77, 0.87) versus 0.97 (0.82, 1.10) p = 0.014	0.92	0.75 (0.58, 0.88)	82	65
Fangberget [65]^b	1.1 versus 1.1 p = 0.693		0.80
Woodhams [64]^c	pCR as in full-text (excl. DCIS)		0.55
	0.81 ± 0.15 versus 0.85 ± 0.19 p = 0.64		0.52
	pCR incl. DCIS: 0.85 ± 0.18 versus 0.85 ± 0.19 p = 0.82
Bufi [17]^d	Overall: 1.132 versus 1.092 p = 0.23	Overall: 0.975	Overall: 0.587
	Luminal: 1.157 versus 1.077 p = 0.59	Luminal: 0.832	Luminal: 0.588
	Hybrid: 1.036 versus 1.079 p = 0.53	Hybrid: 0.959	Hybrid: 0.567
	TN: 1.034 versus 1.114 p = 0.06	TN: 0.995	TN: 0.766
	HER2+: 1.101 versus 1.232 p = 0.05	HER2+: 0.971	HER2+: 0.813
Pereira [18]	Overall: 0.832 ± 0.198 versus 0.853 ± 0.171 p = 0.882
	Luminal B: 0.755 (0.596–1.035) versus 0.802 (0.483–1.090) p = 0.359
	TN: 0.857 (0.448–1.330) versus 1.02 (0.739–1.390) p = 0.070
	HER2: 0.826 (0.651–1.140) versus 0.847 (0.772–0.949) p = 0.522
Santamaria [27]	1.025 ± 0.153 versus 1.072 ± 0.231 p = 0.549
Li [44]		1.22	0.72	93	52	50
Tozaki [40]^e	0.41 versus 0.64 (range 0.46–0.83)	0.45	–	100	100
Che [19]^f (IVIM- > D)	0.92 (0.77, 0.95) versus 0.83 (0.75, 0.92) p = 0.323	0.874	0.600 (0.424–0.759)	69.2 (38.6–90.9)	65.2 (42.7–83.6)	52.9 (28.5–76.1)	78.9 (53.9–93.0)
Kim [53]^g	1.13 (1.01–1.25) versus 1.23 (1.12–1.41) → ADC
	1.10 (1.01–1.22) versus 1.22 (1.10–1.49) → D
Yuan [22]			Luminal A: 0.556
			Luminal B: 0.538
			Basal-like: 0.534
			HER2-Enr.: 0.601
Partridge [23]	1.08 ± 0.16 versus 1.08 ± 0.22
Liu [16]	Luminal A: 1.01 ± 0.12 versus 1.06 ± 0.07 p = 0.293
	Luminal B: 1.01 ± 0.16 versus 1.07 ± 0.08 p = 0.070
	HER2-enriched: 1.05 ± 0.11 versus 1.14 ± 0.07 p = 0.098
	Triple-negative: 1.04 ± 0.08 versus 1.22 ± 0.08 p < 0.001
Bedair [20]	0.92 ± 0.03 versus 1.20 ± 0.02 p < 0.01 → ADC	1.012	0.749	81	67
	0.93 ± 0.04 versus 1.25 ± 0.03 p < 0.01 → DDC	1.141	0.756	81	72
	0.85 ± 0.05 versus 1.02 ± 0.05 p = 0.02 → D	0.838	0.644	60	47
	Other model based measures: 0.81 ± 0.02 versus 0.84 ± 0.02 p = 0.07 → α (a.u.)	0.967	0.641	71	53
Zhang [24]	1 ± 0.2 versus 1 ± 0.2 p = 0.645

ADC apparent diffusion coefficient, CI confidence interval, D true diffusivity, DCIS ductal carcinoma in situ, DDC distributed diffusion coefficient, HER2 human epidermal growth factor receptor 2, f perfusion fraction, ROC AUC area under the receiver operating characteristic curve, NPV negative predictive value, pCR pathologic complete response, PPV positive predictive value, TN triple negative
^aMean ADC-value ± SD with the exception of Che et al. [19]: median ADC and the interquartile range
^b31 MRI at pre NAC and after 4 cycles 27 MRI’s
^cMean and SD calculated by data extraction within the supplementary material, rounded by two decimals, p value calculated with independent samples Mann–Whitney U test, and AUC-ROC in SPSS
^dHybrid tumors: luminal tumors with HER2+; TN: triple negative; data from the HER2+ group represents the HER2-enriched tumors in this case
^eThreshold can be chosen based on ADC-value of the pCR case, resulting in 100% sensitivity and specificity
^fD is the true diffusion coefficient in IVIM
^gMiller and Payne grade 4 included as good responders

Back to article page