Abstract
Objectives: To evaluate the performance of readout-segmented echo-planar imaging DWI (rs-EPI DWI) in detecting and characterizing breast cancers in a large Chinese cohort with comparison to dynamic contrast-enhanced MRI (DCE-MRI).Methods: The institutional review board approved this retrospective study with waived written informed consent. A total of 520 women (mean age, 43.1- ± 10.5-years) were included from July 2013 to October 2019. First, the ability of rs-EPI DWI in detecting breast lesions identified by DCE-MRI was evaluated. The lesion conspicuity of rs-EPI-DWI and DCE-MRI was compared using the Wilcoxon signed rank test. With pathology as a reference, the performance of rs-EPI DWI and DCE-MRI in distinguishing breast cancers was evaluated and compared using the Chi-square test.Results: Of 520 women, 327/520 (62.9%) patients had 423 lesions confirmed by pathology with 203 benign and 220 malignant lesions. The rs-EPI DWI can detect 90.8% (659/726) (reader 1) and 90.6% (663/732) (reader 2) of lesions identified by DCE-MRI. The lesion visibility was superior for DCE-MRI than rs-EPI-DWI (all p < 0.05). With pathology as a reference, the sensitivities and specificities of rs-EPI DWI in diagnosing breast cancers were 95.9% (211/220) and 85.7% (174/203) for reader 1 and 97.7% (215/220) and 86.2% (175/203) for reader 2. No significant differences were found for the performance of DCE-MRI and rs-EPI DWI in discriminating breast cancers (all p > 0.05).Conclusions: Although with an inferior lesion visibility, rs-EPI DWI can detect about 90% of breast lesions identified by DCE-MRI and has comparable diagnostic capacity to that of DCE-MRI in identifying breast cancer.
Highlights
Breast cancer is the most common cancer for women worldwide and has become the leading cause of cancer-related death in Chinese women younger than 45-years old [1, 2]
Dynamic contrast-enhanced MRI (DCE-MRI) is so far the most sensitive imaging modality for identifying breast cancers, and it is recommended for cancer screening of high-risk women as a supplement to mammography and/or breast ultrasound [8, 9]
Of 520 women, fibroglandular tissue (FGT) was observed in 21.7% (113/520) patients with low density and 78.3% (407/520) patients with high density (c and d)
Summary
Breast cancer is the most common cancer for women worldwide and has become the leading cause of cancer-related death in Chinese women younger than 45-years old [1, 2]. Chinese patients contribute significantly to the global burden of breast cancer and related deaths given the large population [1, 3]. Mammography is recommended by clinical guidelines for breast cancer screening in many Western countries for women older than 40-years [5,6,7]. Dynamic contrast-enhanced MRI (DCE-MRI) is so far the most sensitive imaging modality for identifying breast cancers, and it is recommended for cancer screening of high-risk women as a supplement to mammography and/or breast ultrasound [8, 9]. The gadolinium deposition in the body due to repeated injection of GBCAs has attracted broad attention over the world [14], which makes DCE-MRI unreasonable for breast cancer screening in the general population
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