The diagnostic performance of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in evaluating the pathological response of breast cancer to neoadjuvant chemotherapy: A meta-analysis

Purpose: To evaluate and compare the diagnostic performance of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the pathological response of breast cancer to neoadjuvant chemotherapy (NAC). Methods: We searched PubMed, EMBASE, Cochrane Library, and Web of Science systematically to identify relevant studies from inception to December 2020. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the methodological quality of the included studies. We extracted sufficient data to construct 2 x 2 tables and then used STATA 12.0 to perform data pooling, heterogeneity testing, meta-regression analysis and subgroup analysis. Results: A total of 41 articles were enrolled in this study, including 27 studies (2107 patients) on DCE-MRI and 23 studies (1321 patients) on DWI. The pooled sensitivity and specificity of DCE-MRI were 0.75 and 0.79, and the pooled sensitivity and specificity of DWI were 0.77 and 0.75. There was no significant difference in sensitivity (P = 0.598) and specificity (P = 0.218) between DCE-MRI and DWI. And meta-regression analysis showed that both magnetic field strength and the time of examination had significant effects on heterogeneity. Conclusions: DWI might be a potential substitute for DCE-MRI in predicting the pathological response of breast cancer to NAC as there was no significant difference in the diagnostic performance between the two. However, considering that not all included studies directly compared the diagnostic performance of DWI and DCE-MRI in the same patients and the heterogeneity of the included studies, caution should be exercised in applying our results.