Diagnostic performance of ADC values and MRI-based radiomics analysis for detecting lymph node metastasis in patients with cervical cancer: A systematic review and meta-analysis. Issue 156 (November 2022) - Ren, Jing
Highlights: ADC values exhibited a trend to outperform radiomics analysis for detecting LNM. Compared with radiomics analysis, ADC values are more clinically promising. Well-designed radiomics studies are warranted to provide a higher level of evidence. Abstract: Objective: To evaluate and compare the diagnostic performance of apparent diffusion coefficient (ADC) values and MRI-based radiomics analysis for lymph node metastasis (LNM) detection in patients with cervical cancer (CC). Methods: We searched relevant databases for studies on ADC values and MRI-based radiomics analysis for LNM detection in CC between January 2001 and December 2021. Methodological quality assessment of risk of bias using Quality Assessment of Diagnostic Accuracy Studies 2 and radiomics quality score (RQS) of the studies was conducted. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR–), diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated. Diagnostic performance was compared between the two quantitative analyses using a two-sample Z-test. Results: In total, 22 studies including 2314 patients were included. Unclear risk of bias was observed in 4.5–36.4% of the studies. The 8 radiomics studies exhibited a median (interquartile range) RQS of 13.5 (5.5–15.75). The pooled sensitivity, specificity, LR+, LR–, DOR, and AUC of the ADC values vs radiomics analysis were 0.86 vs 0.84, 0.85 vs 0.73, 5.7 vs 3.1, 0.17 vs 0.22, 34 vs 14, and 0.91 vs 0.86, respectively. There was no threshold effect or publication bias, but significant heterogeneity existed among the studies. No significant difference was detected in the diagnostic performance of the two quantitative analyses using the Z-test. Conclusion: ADC values are more clinically promising because they are more easily accessible and widely applied, and exhibit a non-statistically significant trend to outperform radiomics analysis.