Abstract
Diffusion-weighted imaging (DWI) has not been well explored in differentiation of malignant from benign breast lesions. The aims of this study were to examine the role of apparent diffusion coefficient (ADC) values in differentiation of malignant from benign tumors and distinguishing histological subtypes of malignant lesions, and to determine correlations between ADC values and breast tumors structure. This cohort-study included 174 female patients who underwent contrast-enhanced breast MR examination on a 3T scanner and were divided into two groups: patient group (114 patients with proven tumors) and control group (60 healthy patients). One-hundred-thirty-nine lesions (67 malignant and 72 benign) were detected and pathohistologically analyzed. Differences between variables were tested using chi-square test; correlations were determined using Pearson's correlation test. For determination of cut off values for diagnostic potential, Receiver Operating Characteristic curves were constructed. Statistical significance was set at p < 0.05. Mean ADC values were significantly lower in malignant compared to benign lesions (0.68 × 10−3mm2/s vs. 1.12 × 10−3mm2/s, p < 0.001). The cut off value of ADC for benign lesions was 0.792 × 10−3mm2/s (sensitivity 98.6%, specificity 65.7%), and for malignant 0.993 × 10−3mm2/s (98.5, 80.6%). There were no significant correlations between malignant lesion subtypes and ADC values. DWI is a clinically useful tool for differentiation of malignant from benign lesions based on mean ADC values. The cut off value for benign lesions was higher than reported recently, due to high amount of fibrosis in included benign lesions. Finally, ADC values might have implications in determination of the biological nature of the malignant lesions.
Highlights
Magnetic resonance imaging (MRI) of the breast has an important role in detection, evaluation and follow-up of breast lesions
Differences in the apparent diffusion coefficient (ADC) values between different benign lesion types are shown on Figure 2, and between different malignant lesions on Figure 3
ADC values were significantly lower in malignant lesions compared to benign
Summary
Magnetic resonance imaging (MRI) of the breast has an important role in detection, evaluation and follow-up of breast lesions. This diagnostic modality is based both on the analysis of morphologic parameters (available from conventional, native MRI) and the kinetic features of the lesion (available from dynamic contrast-enhanced (DCE) study) [1]. Diffusion-weighted imaging (DWI) represents an MRI technique that depicts Brownian motion of water molecules, indirectly showing the degree of tissue cellularity and integrity of cell membranes [4]. Breast cancers typically present with restricted diffusion of water molecules, observed as increase in DWI signal, and lower apparent diffusion coefficient (ADC) values compared to normal surrounding tissue and benign lesions of the breast [5]. Some benign breast lesions show low apparent diffusion coefficient (ADC) values, while ductal carcinoma in situ (DCIS) can show higher ADC values than invasive carcinoma
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