Evaluation of Breast Cancer Morphology Using Diffusion‐Weighted and Dynamic Contrast‐Enhanced MRI: Intermethod and Interobserver Agreement

Abstract

Background The capability of diffusion‐weighted imaging (DWI) for morphological analysis of breast lesions is underexplored. Purpose To evaluate the utility of DWI for assessment of morphological features of breast cancer by comparing DWI and dynamic contrast‐enhanced (DCE) MRI findings to determine intermethod and interobserver agreement. Study Type Retrospective. Population Seventy‐eight women with pathohistologically proven breast cancer. Field Strength/Sequence 1.5T. DWI and DCE images. Assessment Diffusion‐weighted and DCE images were placed in two separate case sets. Three radiologists, blinded to all other information, independently evaluated each case set on two separate occasions. Lesions were interpreted according to the fifth edition of the ACR BI‐RADS lexicon. Statistical Analysis Kappa (κ) statistics were calculated in order to assess intermethod and interobserver agreement. Results For values that attained statistical significance (P < 0.05), intermethod agreement ranged from fair (κ = 0.22) for nonmass internal patterns to significant (κ = 0.8) for lesion type. On DWI, interobserver agreement varied from fair (κ = 0.34) for mass shape to significant (κ = 0.75) for lesion type. On DCE MRI, interobserver agreement varied from fair (κ = 0.27) for irregular vs. spiculated mass margin to perfect (κ = 1) for circumscribed vs. noncircumscribed mass margin. Data Conclusion On the whole, there was moderate intermethod agreement. The values of interobserver agreement were mostly similar between DWI and DCE MRI. This suggests that DWI is applicable for morphological assessment of breast cancer, notwithstanding substantially inferior spatial resolution compared to DCE MRI. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:1381–1390.

Evaluation of Malignant Breast Lesions Using High-resolution Readout-segmented Diffusion-weighted Echo-planar Imaging: Comparison with Pathology

“…However, they did not perform the statistical analysis for the smaller lesion subgroup (<2 cm) due to the lower number of complete observer agreements for this lesion size. 30 In that respect, our study can be valuable evidence, performing detailed assessment of non-mass lesions with HR-DWI, including comparison with pathology.…”

“…While most previous papers focused on ADC values obtained from DWI, there are a few reports concerning morphological assessment of breast lesions using ss-EPI with an HR-DWI Using rs-EPI for Breast 1.5T MRI scanner. 30,31 Another report showed the additive diagnostic value in analysis of breast lesion using rs-EPI (voxel size: 2.1 × 1.8 × 4.0 mm 3 ) with a 3T MRI scanner. 23 These previous reports pointed out the value of less-distorted DWI.…”

Diffusion-Weighted Magnetic Resonance Imaging of the Breast: Standardization of Image Acquisition and Interpretation

“…In case of the lesions categorized as masses, shape (round/oval, irregular) and internal signal pattern (homogeneous, heterogeneous, rim) can be reported, whereas in non-mass lesions, distribution (focal, regional, linear, segmental) and internal signal pattern kjronline.org (homogeneous, heterogeneous) can be reported (13). Qualitative evaluation of the lesion morphology might be of assistance in avoiding the misclassification of false-positive benign lesions, such as complicated cysts or fibroadenomas, as well as to avoid misdiagnosis of false-negative malignant lesions, including mucinous carcinoma or invasive breast cancer with extensive necrosis (42).…”

Application of MRI Image Based on Computer Semiautomatic Segmentation Algorithm in the Classification Prediction of Breast Cancer Histology

“…DWI is able to perform detection in vivo using microscopic motion imaging of water molecules. They are usually used in combination to diagnose breast cancer [ 7 ].…”