Abstract

BackgroundAvailable data proving the value of DWI for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions. The objective of this study was to assess the diagnostic accuracy of DWI using different ROI measurement approaches and ADC metrics in breast lesions presenting as NME lesions on dynamic contrast-enhanced (DCE) MRI.MethodsIn this retrospective study, 95 patients who underwent multiparametric MRI with DCE and DWI from September 2007 to July 2013 and who were diagnosed with a suspicious NME (BI-RADS 4/5) were included. Twenty-nine patients were excluded for lesion non-visibility on DWI (n = 24: 12 benign and 12 malignant) and poor DWI quality (n = 5: 1 benign and 4 malignant). Two readers independently assessed DWI and DCE-MRI findings in two separate randomized readings using different ADC metrics and ROI approaches. NME lesions were classified as either benign (> 1.3 × 10−3 mm2/s) or malignant (≤ 1.3 × 10−3 mm2/s). Histopathology was the standard of reference. ROC curves were plotted, and AUCs were determined. Concordance correlation coefficient (CCC) was measured.ResultsThere were 39 malignant (59%) and 27 benign (41%) lesions in 66 (65 women, 1 man) patients (mean age, 51.8 years). The mean ADC value of the darkest part of the tumor (Dptu) achieved the highest diagnostic accuracy, with AUCs of up to 0.71. Inter-reader agreement was highest with Dptu ADC max (CCC 0.42) and lowest with the point tumor (Ptu) ADC min (CCC = − 0.01). Intra-reader agreement was highest with Wtu ADC mean (CCC = 0.44 for reader 1, 0.41 for reader 2), but this was not associated with the highest diagnostic accuracy.ConclusionsDiagnostic accuracy of DWI with ADC mapping is limited in NME lesions. Thirty-one percent of lesions presenting as NME on DCE-MRI could not be evaluated with DWI, and therefore, DCE-MRI remains indispensable. Best results were achieved using Dptu 2D ROI measurement and ADC mean.

Highlights

  • Available data proving the value of Diffusion-weighted imaging (DWI) for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions

  • Patients A prospectively and consecutively populated research database was searched for patients who underwent multiparametric Magnetic resonance imaging (MRI) of the breast with dynamic contrast-enhanced (DCE) and DWI between September 2007 and July 2013 and who fulfilled the following inclusion criteria: 18 years or older; not pregnant; not breastfeeding; no previous breast cancer treatment; presence of NME (BI-RADS 4–5) on DCEMRI suspicious according to Breast Imaging Reporting and Data System (BI-RADS) lexicon, i.e., unilateral with segmental, focal, or linear distribution; and no contraindications for MRI or MRI contrast agents

  • Up to a third of NMEs cannot be evaluated with DWI, and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is still indispensable for detection and characterization of NME lesions

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Summary

Introduction

Available data proving the value of DWI for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions. While it has been shown that a 2D region of interest (ROI) ADC measurement approach in the enhancing tumor with the visually assessed lowest ADC is the most practical and diagnostically accurate measurement in mass lesions [21,22,23], the best and most reliable measurement in NME lesions remains unclear. To close these gaps in knowledge, the aim of this study was to assess the diagnostic accuracy of DWI using different ROI measurement approaches and ADC metrics in breast lesions presenting as NME lesions on DCEMRI and to assess inter-reader agreement and repeatability of ADC measurements

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