Tarigan Vera Nevyta, Kusumaningtyas Nungky, Supit Nina I S H, Sanjaya Edwin, Chandra Malvin, Sulay Callistus Bruce Henfry, Octavius Gilbert Sterling
Breast and Female Reproductive Radiology, Department of Radiology, Faculty of Universitas Pelita Harapan, Tangerang 15811, Indonesia.
Department of Radiology, Siloam Hospital Kebon Jeruk, Jakarta 11530, Indonesia.
J Clin Med. 2025 Jun 30;14(13):4628. doi: 10.3390/jcm14134628.
: This study systematically evaluates the diagnostic accuracy of dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) values. : The literature search started and ended on 10 June 2024. We searched MEDLINE, Cochrane Library, Pubmed, Science Direct, and Google Scholar. Our research question could be formulated as "In women with NME detected by MRI, how accurate are DCE and DWI in ruling in and ruling out malignancy when the diagnosis is compared to histopathology analysis with or without a clinical follow-up?". The meta-analysis was conducted using the STATA 17 software with the "midas" commands. The study protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) database. : Fifty-four studies involving 6121 NME lesions were analyzed. The combined use of DCE-MRI and DWI demonstrated the highest diagnostic accuracy (AUC: 0.91; 95% CI: 0.88-0.93), followed by DWI alone (AUC: 0.85; 95% CI: 0.81-0.87) and ADC (AUC: 0.77; 95% CI: 0.74-0.81). DCE-MRI alone showed the lowest performance (AUC: 0.68; 95% CI: 0.64-0.72). Significant heterogeneity was observed across all modalities, with I values exceeding 95% in several analyses. The likelihood ratio scattergram indicated that no modality reliably confirmed or excluded malignancy. : While the combination of DCE-MRI and DWI achieves the highest diagnostic accuracy, no modality can reliably differentiate benign from malignant NME lesions. Standardized imaging protocols and refined diagnostic descriptors are needed for clinical improvement.
本研究系统评估了动态对比增强磁共振成像（DCE-MRI）、扩散加权成像（DWI）及表观扩散系数（ADC）值的诊断准确性。文献检索于2024年6月10日开始并结束。我们检索了MEDLINE、Cochrane图书馆、Pubmed、Science Direct和谷歌学术。我们的研究问题可表述为“在MRI检测出NME的女性中，与有或无临床随访的组织病理学分析相比，DCE和DWI在诊断和排除恶性肿瘤方面的准确性如何？”。使用STATA 17软件及“midas”命令进行荟萃分析。该研究方案已在国际前瞻性系统评价注册库（PROSPERO）数据库中注册。分析了涉及6121个NME病变的54项研究。DCE-MRI和DWI联合使用显示出最高的诊断准确性（AUC：0.91；95%CI：0.88 - 0.93），其次是单独使用DWI（AUC：0.85；95%CI：0.81 - 0.87）和ADC（AUC：0.77；95%CI：0.74 - 0.81）。单独的DCE-MRI表现最差（AUC：0.68；95%CI：0.64 - 0.72）。在所有模式中均观察到显著的异质性，在几项分析中I值超过95%。似然比散点图表明，没有一种模式能可靠地确诊或排除恶性肿瘤。虽然DCE-MRI和DWI联合使用可达到最高的诊断准确性，但没有一种模式能可靠地区分良性和恶性NME病变。需要标准化的成像方案和完善的诊断描述符以改善临床情况。
