Limited role of DWI with apparent diffusion coefficient mapping in breast lesions presenting as non-mass enhancement on dynamic contrast-enhanced MRI

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.

Diagnostic value of diffusion-weighted imaging with synthetic b-values in breast tumors: comparison with dynamic contrast-enhanced and multiparametric MRI

“…Among those lesions missed, the majority of them were either small (≤ 10 mm) or NMLE. This is in agreement with prior studies investigating DWI with ADC mapping that showed that lesions missed with DWI were either small or NMLE [ 16 , 31 , 32 ]. This is potentially problematic if one of the future roles of DWI is to be a reliable tool in breast cancer detection and not only in the characterization of lesions found in other imaging modalities.…”

Comparison of Diagnostic Efficacy Between Contrast-Enhanced Ultrasound and DCE-MRI for Mass- and Non-Mass-Like Enhancement Types in Breast Lesions

“…Therefore, the diagnosis and treatment of breast cancer have become a global problem. Detecting and diagnosing breast cancer in early stages (tumor size <20 mm) greatly contributes to the prognosis 3–7 and is an effective strategy to reduce mortality rate, extend patient survival time, and improve the quality of life. Breast lesions are divided into mass-like and non-mass-like types.…”

Detection of recurrent breast carcinoma using unenhanced breast MRI

“…According to the BI-RADS lexicon, nonmass enhancement is an enhancement of an area that is not a mass, typically occurring in an area of fibroglandular tissue that appears as normal on unenhanced images [7]. Avendano et al [16] performed a study to evaluate the diagnostic accuracy of DWI and ADC values in assessment of lesions presenting as non-mass enhancement on DCE-MRI and concluded that 31% of lesions presented as non-mass enhancement on dynamic MRI could not be adequately evaluated by DWI. On the basis of our unenhanced MR images, we missed 2 cases of recurrent breast carcinoma that presented as non-mass enhancement on dynamic MR images.…”