Abstract
Objective:To test the use of diffusion-weighted imaging (DWI) in stratifying suspicious breast lesions (BI-RADS 4), correlating them with histopathology. We also investigated the performance of DWI related to the main enhancement patterns (mass and non-mass) and tested its reproducibility.Materials and Methods:Seventy-six patients presented 92 lesions during the sampling period. Two independent examiners reviewed magnetic resonance imaging studies, described the lesions, and determined the apparent diffusion coefficient (ADC) values. Differences among benign, indeterminate- to high-risk, and malignant findings, in terms of the ADCs, were assessed by analysis of variance. Using receiver operating characteristic (ROC) curves, we compared the performance of ADC values in masses and non-mass lesions, and tested the reproducibility of measurements by determining the coefficient of variation and smallest real difference.Results:Among the 92 lesions evaluated, the histopathology showed that 37 were benign, 11 were indeterminate- to high-risk, and 44 were malignant. The mean ADC differed significantly among those histopathological groups, the value obtained for the malignant lesions (1.10 × 10-3 mm2/s) being significantly lower than that obtained for the other groups (p < 0.001). ROC curves demonstrated that DWI performed better when applied to masses than when applied to non-mass lesions (area under the curve, 0.88 vs. 0.67). Reproducibility was good (coefficient of variation, 7.03%; and smallest real difference, ± 0.242 × 10-3 mm2/s).Conclusion:DWI can differentiate between malignant and nonmalignant (benign or indeterminate- to high-risk) lesions, showing better performance for masses. Nevertheless, stratification based on histopathological criteria that are more refined has yet to be achieved.
Highlights
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become established as the most sensitive method for breast cancer detection, with acceptable, albeit low, specificity[1,2]
On the basis of the apparent diffusion coefficient (ADC) values, it was not possible to separate the non-mass enhancement patterns into malignant and nonmalignant types (p = 0.071), the area under the curve (AUC) indicated that the ADC performed significantly better in that regard for the mass enhancement patterns (Figure 4)
We found that the mean ADC was lower for any type of lesion than for the normal breast parenchyma
Summary
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become established as the most sensitive method for breast cancer detection, with acceptable, albeit low, specificity[1,2]. New techniques applied to MRI, such as spectroscopy and diffusion-weighted imaging (DWI), have been producing encouraging results and have expanded the field for oncology studies[3]. Among the novel MRI procedures, DWI is regarded as one of the most promising methods of screening for malignancy and evaluating treatment response[5]. Most modern scanners are capable of employing DWI, which has short acquisition times, does not require the use of paramagnetic contrast medium, and, above all, has shown a potential to improve the specificity of MRI[7]
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