Purpose:To evaluate the role of diffusion-weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors. Materials and Methods:Sixty-seven women with invasive cancer underwent breast MRI. Histological specimens were analyzed for tumor size and grade, and expression of estrogen receptors (ER), progesterone receptors, c-erbB-2, p53, Ki-67, and epidermal growth factor receptors. The computed mean ADC values of breast cancer and normal breast parenchyma were compared. Relationships between the ADC values and prognostic factors were determined using Wilcoxon signed rank test and Kruskal-Wallis test.Results: DWI detected breast cancer as a hyperintense area in 62 patients (92.5 %). A statistically significant difference in the mean ADC values of breast cancer (1.09 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) and normal parenchyma (1.59 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) was detected (P Ͻ 0.0001). There were no correlations between the ADC value and prognostic factors. However, the median ADC value was lower in the ER-positive group than the ER negative group, and this difference was marginally significant (1.09 ϫ 10 Ϫ5 mm 2 /s versus 1.15 ϫ 10 Ϫ5 mm 2 /s, P ϭ 0.053). Conclusion:The ADC value was a helpful parameter in detecting malignant breast tumors, but ADC value could not predict patient prognosis. DYNAMIC CONTRAST MATERIAL-enhanced MRI, which gives information on morphology and kinetics and has higher sensitivity, is frequently used to identify additional lesions and to determine the extent of tumor before surgery (1). In recent years, some studies have attempted to differentiate between benign and malignant tumors using diffusion-weighted imaging (DWI) (2-9). DWI is a specific modality that visualizes the microstructural characteristics of water diffusion in biological tissues. The microscopic motion includes the molecular diffusion of water and blood microcirculation in capillary networks; therefore, both diffusion and perfusion affect apparent diffusion coefficient (ADC) values (2,10). The ADC value was determined to be lower in cancer compared with normal parenchyme or benign breast tumor (2-9). Many studies have attempted to predict treatment response and prognosis in patients with breast cancer. It has been disclosed that there are traditional prognostic factors such as tumor grade and molecular markers such as estrogen receptors (ER) and progesterone receptors (PR) (11). Of these prognostic factors, the histologic grade of the tumor and the Ki-67 proliferation index reflect the cellularity (5,8,12,13), and c-erbB-2 and ER are thought to be associated with perfusion (14,15). We have speculated that these prognostic factors can affect the ADC value.To our knowledge, no studies have examined the correlation between the ADC value and prognostic factors. The objectives of the current study are to examine the clinical usefulness of DWI for the detection of invasive cancer, and to determine whether the ADC value can be a new prognostic factor for patients with...

Purpose: To evaluate the correlation of the mean and minimal apparent diffusion coefficient values (ADC mean , ADC minimal ) and dynamic magnetic resonance imaging (MRI) findings with prognostic factors in invasive ductal carcinoma. Materials and Methods:A total of 107 women with invasive ductal cancer underwent breast MRI. The ADC mean and ADC minimal of the cancers were computed. MRI findings were retrospectively evaluated according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon: mass or nonmass type, mass shape, mass margin, nonmass distribution, and enhancement pattern. Histological records were reviewed for tumor size, lymph node metastasis, histologic grade, and expression of estrogen receptors (ER), progesterone receptors (PR), c-erbB-2(HER2), Ki-67, and epidermal growth factor receptors (EGFR). Correlations of ADC values and MR findings with prognostic factors were determined using the Mann-Whitney U-test and the Kruskal-Wallis test.Results: The mean ADC minimal was 0.78 6 0.24 (Â10 À3 mm 2 /s), and the mean ADC mean was 1.01 6 0.23 (Â10 À3 mm 2 /s). There was a significant correlation of the ADCmean value with ER expression (P ¼ 0.027) and HER2 expression (P ¼ 0.018). There was no significant relationship between ADC minimal and prognostic factors or between ADC mean and traditional prognostic factors, PR, Ki-67 and EGFR. The majority of the mass type lesions were less than 5 cm in size and the majority of nonmass type lesions were more than 2 cm in size (P ¼ 0.022). The margin of mass was significantly associated with lymph node metastasis (P ¼ 0.031), ER expression (P ¼ 0.013), PR expression (P ¼ 0.036), HER2 expression (P ¼ 0.019), and EGRF expression (P ¼ 0.041). The rim internal enhancement was significantly correlated with Ki-67 expression (P ¼ 0.008). Conclusion:The low ADC mean value was related to positive expression of ER and negative expression of HER2. A spiculated margin was related to a good prognosis, but rim enhancement was associated with a poor prognosis.

Objective: This study aims to evaluate the degree of inter-and intraobserver agreement when characterizing breast abnormalities using the Breast Imaging Reporting and Data System (BI-RADS)-ultrasound (US) lexicon, as defined by the American College of Radiology (ACR). Materials and Methods:Two hundred ninety three female patients with 314 lesions underwent US-guided biopsies at one facility during a two-year period. Static sonographic images of each breast lesion were acquired and reviewed by four radiologists with expertise in breast imaging. Each radiologist independently evaluated all cases and described the mass according to BI-RADS-US. To assess intraobserver variability, one of the four radiologists reassessed all of the cases one month after the initial evaluation. Inter-and intraobserver variabilities were determined using Cohen's kappa (k) statistics. Results:The greatest degree of reliability for a descriptor was found for mass orientation (k = 0.61) and the least concordance of fair was found for the mass margin (k = 0.32) and echo pattern (k = 0.36). Others descriptive terms: shape, lesion boundary and posterior features (k = 0.42, k = 0.55 and k = 0.53, respectively) and the final assessment (k = 0.51) demonstrated only moderate levels of agreement. A substantial degree of intraobserver agreement was found when classifying all morphologic features: shape, orientation, margin, lesion boundary, echo pattern and posterior feature (k = 0.73, k = 0.68, k = 0.64, 0.68, k = 0.65 and k = 0.64, respectively) and rendering final assessments (k = 0.65). Conclusion:Although BI-RADS-US was created to achieve a consensus among radiologists when describing breast abnormalities, our study shows substantial intraobserver agreement but only moderate interobserver agreement in the mass description and final assessment of breast abnormalities according to its use. A better agreement will ultimately require specialized education, as well as self-auditing practice tests.lthough mammography remains the 'gold' standard for breast screening, the use of ultrasound (US) can improve the specificity of mammography, reduce the number of false negatives for breast cancer diagnosis in dense breasts, and reduce the number of false positive recommendations for a biopsy (1 3). However, there are several inherent disadvantages of US examinations. The most important drawbacks are that US examinations are highly operator-dependent and their lack of reproducibility. Another continuing problem is a lack of a standardized method for lesion characterization and recommendations, which creates confusion among physicians, radiologists and patients. To address this shortcoming, a US lexicon was created and published in the fourth edition of the Breast Imaging Reporting and Data System (BI-RADS), based on the success of BI-RADS with mammography (1).

ObjectiveThe purpose of this study was to compare the image quality of standard single-shot echo-planar imaging (ss-EPI) and that of readout-segmented EPI (rs-EPI) in patients with breast cancer.Materials and MethodsSeventy-one patients with 74 breast cancers underwent both ss-EPI and rs-EPI. For qualitative comparison of image quality, three readers independently assessed the two sets of diffusion-weighted (DW) images. To evaluate geometric distortion, a comparison was made between lesion lengths derived from contrast enhanced MR (CE-MR) images and those obtained from the corresponding DW images. For assessment of image parameters, signal-to-noise ratio (SNR), lesion contrast, and contrast-to-noise ratio (CNR) were calculated.ResultsThe rs-EPI was superior to ss-EPI in most criteria regarding the qualitative image quality. Anatomical structure distinction, delineation of the lesion, ghosting artifact, and overall image quality were significantly better in rs-EPI. Regarding the geometric distortion, lesion length on ss-EPI was significantly different from that of CE-MR, whereas there were no significant differences between CE-MR and rs-EPI. The rs-EPI was superior to ss-EPI in SNR and CNR.ConclusionReadout-segmented EPI is superior to ss-EPI in the aspect of image quality in DW MR imaging of the breast.