Abstract
ObjectiveTo assess the role of diffusion-weighted imaging (DWI) in the evaluation of breast lesions classified as suspicious on magnetic resonance imaging (MRI), correlating the findings with the results of the histological analysis.Materials and MethodsThis was a retrospective, descriptive study based on a review of the medical records of 215 patients who were submitted to MRI with DWI before undergoing biopsy at a cancer center. Apparent diffusion coefficient (ADC) values were calculated for each lesion, and the result of the histological analysis was considered the gold standard.ResultsThe mean age was 49 years. We identified 252 lesions, 161 (63.9%) of which were found to be malignant in the histological analysis. The mean ADC value was higher for the benign lesions than for the malignant lesions (1.50 × 10–3 mm2/s vs. 0.97 × 10−3 mm2/s), the difference being statistically significant (p < 0.001). The ADC cut-off point with the greatest sensitivity and specificity on the receiver operating characteristic curve was 1.03 × 10−3 mm2/s. When the DWI and conventional MRI findings were combined, the accuracy reached 95.9%, with a sensitivity of 95.7% and a specificity of 96.4%.ConclusionThe use of DWI could facilitate the characterization of breast lesions, especially those classified as BI-RADS 4, increasing the specificity and diagnostic accuracy of MRI.
Highlights
Because it provides information regarding the vascularization of the breast parenchyma, magnetic resonance imaging (MRI) has greater sensitivity in the detection of breast cancer than do mammography and ultrasound, Received May 22, 2016
PhD, MD, Radiologist, Director of the Imaging Department of the A.C.Camargo Cancer Center, São Paulo, SP, Brazil. Because it provides information regarding the vascularization of the breast parenchyma, magnetic resonance imaging (MRI) has greater sensitivity in the detection of breast cancer than do mammography and ultrasound, Mailing address: Dr Almir Galvão Vieira Bitencourt
For the distinction between benign and malignant lesions, the Breast Imaging Reporting and Data System (BI-RADS) MRI classification had a sensitivity of 100%, a specificity of 54.9%, a positive predictive value (PPV) of 79.7%, a negative predictive value (NPV) of 100%, and an accuracy of 83.7%
Summary
Because it provides information regarding the vascularization of the breast parenchyma, magnetic resonance imaging (MRI) has greater sensitivity in the detection of breast cancer than do mammography and ultrasound, Received May 22, 2016. MRI shows greater accuracy in assessing the extent of the disease and in detecting additional lesions in the contralateral breast during staging, thereby improving surgical and treatment planning[2,3,4]. New MRI techniques have been developed with the objective of adding functional information to the morphological and kinetic analysis, in order to improve the specificity of the method. Among such techniques, diffusion-weighted imaging (DWI) is the one that is currently being most widely studied[5]
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