Differentiation of Breast Lesions and Distinguishing Their Histological Subtypes Using Diffusion-Weighted Imaging and ADC Values

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 −3 mm 2 /s vs. 1.12 × 10 −3 mm 2 /s, p < 0.001). The cut off value of ADC for benign lesions was 0.792 × 10 −3 mm 2 /s (sensitivity 98.6%, specificity 65.7%), and for malignant 0.993 × 10 −3 mm 2 /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.

Application of Diffusion Weighted Imaging Techniques for Differentiating Benign and Malignant Breast Lesions

“…MRI can not only analyze the nature of the lesion through morphological features, but also obtain a variety of quantitative parameters using functional imaging sequences for more objective evaluation and diagnosis (6). Diffusion weighted MRI (DW-MRI), which indirectly reflects the degree of tissue differentiation and the integrity of cell membranes, is routinely used to improve the accuracy of differential breast lesion diagnoses (7)(8)(9).…”

“…The ADC model requires two bvalues to fit the curve. Many studies have shown that ADC has a certain significance in the identify of benign and malignant breast lesions (8,9). The intravoxel incoherent motion (IVIM) model is first proposed by Bihan et al (12) and has been reported to have good diagnostic performance for the diagnosis of pancreatic ductal adenocarcinoma (13).…”

“…The single exponential model is useful to distinguish benign from malignant breast lesions, and has been most widely used in clinical practice because of its short scanning time and simple post-processing ( 8 , 10 , 11 ). The ADC model requires two b-values to fit the curve.…”

“…The ADC model requires two b-values to fit the curve. Many studies have shown that ADC has a certain significance in the identify of benign and malignant breast lesions ( 8 , 9 ). The intravoxel incoherent motion (IVIM) model is first proposed by Bihan et al.…”

Differentiation of Benign and Malignant Breast Lesions Using ADC Values and ADC Ratio in Breast MRI

“…However, MRI has a high sensitivity but lower specificity (93% and 71%, respectively) [ 21 ] in the assessment of breast lesions. Recent studies [ 20 , 21 , 22 , 23 , 24 ] have suggested that the additional evaluation of the diffusion properties of breast lesions can improve specificity; ADC, measured in DWI, is thus being increasingly used as a marker in the detection and characterization of breast lesions [ 21 ]. Furthermore, other authors added to this additional ADC ratio calculation [ 25 , 26 ].…”