Abstract
Purpose:To determine the contribution of apparent diffusion coefficient (ADC), and relative ADC (rADC) values to differentiate between benign and malignant breast masses.Materials and Methods:Magnetic resonance imaging (MRI) of the breast with diffusion-weighted imaging (DWI) of patients with benign or malignant breast masses diagnosed either by histopathological findings or by follow-up imaging were evaluated retrospectively. Histopathological analyses were performed for 71 lesions (80.7%) while the remaining were followed up every six months for one year. DWI was performed using b-values of 0 and 1000 sec/mm2, and ADC and rADC were calculated and compared. A receiver operating characteristic (ROC) curve and Youden index were used to evaluate the parameter’s optimal threshold and diagnostic value. Statistical significance was set as p < 0.05.Results:Eighty-eight lesions from a total of 81 patients, aged between 16 and 73 (mean age 42 ± 11.3) years were obtained and evaluated. Pathological results of 34 (38.6%) out of 71 lesions were malignant and 37 lesions (42%) were benign. Seventeen (19.3%) lesions remained stable at one-year follow-up and were accepted as benign breast masses. Mean ADC values of benign and malignant lesions were 1.584 × 10–3mm2/sec and 0.884 × 10–3mm2/sec (p < 0.05), respectively. Sensitivity and specificity of ADC were 88% and 87%, respectively at a cut-off value of 1.04 × 10–3mm2/sec. Mean rADC was 0.931 for benign lesions and 0.557 for malignant lesions (p < 0.05). Sensitivity and specificity were 82% and 83% at a cut-off value of 0.639. No prominent superiority of rADC over ADC is identified in the differentiation of breast masses.Conclusion:ADC and rADC values derived from DWI can be equally useful in clinical setting to differentiate benign from malignant breast masses.
Highlights
Mammography remains the sole fundamental imaging method in diagnosis and screening of breast cancer [1]
We introduced the Relative ADC (rADC) and apparent diffusion coefficient (ADC) values to differentiate benign and malignant breast masses and compared their diagnostic performance
The diagnostic performance of ADC value to differentiate malign breast masses from benign masses was as follows: sensitivity 88% (CI 95%; 72–96), specificity 87% (CI 95%; 74–94), positive predictive value (PPV) 81% (CI 95%; 64–91), negative predictive value (NPV) 92% (CI 95%; 80–97), and accuracy is 88% using an ADC cut-off value of 1.04 × 10–3mm2/sec
Summary
Mammography remains the sole fundamental imaging method in diagnosis and screening of breast cancer [1]. The use of magnetic resonance imaging (MRI) as an addition to conventional methods in the diagnosis of primary or recurrent breast cancer has been gradually increasing [2]. Advances in MRI technology (dedicated breast coils and quick imaging sequences) led to the inclusion of diffusion-weighted imaging (DWI) in breast studies by Englander et al in 1997 [4]. The apparent diffusion coefficient (ADC) values obtained from DWI are affected by menstrual cycle and hormone replacement therapy [5, 6]. We introduced the rADC and ADC values to differentiate benign and malignant breast masses and compared their diagnostic performance
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