<Diagnostic Effectiveness of USPIO versus Gadolinium Based MRI for Axillary Metastasis in Breast Cancer: A Meta-analysis>

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<iMRI 2015;19.1:37-46>

Yoonseok Kim, Eunae Jae, Junggu Park

Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
Department of Obstetrics and Gynecology, Mirae Woman’s Hospital, Busan, Korea
Department of Radiology, Kosin University Gospel Hospital, Busan, Korea

Purpose
This report compared the diagnostic effectiveness between ultrasmall superparamagnetic iron oxide (USPIO) and gadolinium (Gd) based magnetic resonance imaging (MRI) for differentiation of axillary status in breast cancer patients.

Materials and Methods
The present authors performed a meta-analysis of previous studies that compared USPIO or Gd based MRI with histological diagnosis after surgery or biopsy. We searched PubMed, EMBASE, Cochrane Library, ScienceDirect, SpringerLink, Ovid databases and references of articles to identify studies reporting data until December 2013. Pooled sensitivity and specificity were calculated for every study; summary receiver operating characteristic and subgroup analysis was done. Analyses of study quality and heterogeneity were also assessed.

Results
There were 14 publications that met the criteria for inclusion in our meta-analysis. USPIO based MRI showed 0.83 (95% CI: 0.75-0.89) and 0.97 (95% CI: 0.94-0.98) for pooled sensitivity and specificity, respectively. Gd based MRI represented pooled sensitivity and specificity of 0.61 (95% CI: 0.55-0.67) and 0.90 (95% CI: 0.87-0.92) for each. Overall weighted area under the curve for USPIO and Gd based MRI were 0.9563 and 0.9051, respectively.

Conclusion
USPIO based MRI had a tendency toward high pooled sensitivity and
specificity in detection of axillary metastases for breast cancer. This result may mean that USPIO based MRI could be used as complementary modality to differentiate axillary status more precisely, and assist in the decision-making process regarding possible invasive procedures, such as sentinel node biopsy.

Keywords
Breast neoplasm; Lymphatic metastasis; Magnetic resonance imaging; Nanoparticles