Risk stratification of suspicious lesions (BI-RADS category 4) can be satisfactorily performed with DCE-MRI and slightly improved when DWI is introduced.
ObjectiveTo determine the positive predictive value (PPV) and likelihood ratio for
magnetic resonance imaging (MRI) characteristics of category 4 lesions, as
described in the Breast Imaging Reporting and Data System
(BI-RADS®) lexicon, as well as to test the predictive
performance of the descriptors using multivariate analysis and the area
under the curve derived from a receiver operating characteristic (ROC)
curve.Materials and MethodsThis was a double-blind review study of 121 suspicious findings from 98 women
examined between 2009 and 2013. The terminology was based on the 2013
edition of the BI-RADS.ResultsOf the 121 suspicious findings, 53 (43.8%) were proven to be malignant
lesions, with no significant difference between mass and non-mass
enhancement (p = 0.846). The PPVs were highest for masses
with a spiculated margin (71%) and round shape (63%), whereas segmental
distribution achieved a high PPV (80%) for non-mass enhancement. Kinetic
analyses performed poorly, except for type 3 curves applied to masses (PPV
of 73%). Logistic regression models were significant for both patterns,
although the results were better for masses, particularly when kinetic
assessments were included (p = 0.015; pseudo
R2 = 0.48; area under the curve =
90%).ConclusionSome BI-RADS MRI descriptors have high PPV and good predictive performance-as
demonstrated by ROC curve and multivariate analysis-when applied to BI-RADS
category 4 findings. This may allow future stratification of this
category.
Objective:To test the use of diffusion-weighted imaging (DWI) in stratifying suspicious
breast lesions (BI-RADS 4), correlating them with histopathology. We also
investigated the performance of DWI related to the main enhancement patterns
(mass and non-mass) and tested its reproducibility.Materials and Methods:Seventy-six patients presented 92 lesions during the sampling period. Two
independent examiners reviewed magnetic resonance imaging studies, described
the lesions, and determined the apparent diffusion coefficient (ADC) values.
Differences among benign, indeterminate- to high-risk, and malignant
findings, in terms of the ADCs, were assessed by analysis of variance. Using
receiver operating characteristic (ROC) curves, we compared the performance
of ADC values in masses and non-mass lesions, and tested the reproducibility
of measurements by determining the coefficient of variation and smallest
real difference.Results:Among the 92 lesions evaluated, the histopathology showed that 37 were
benign, 11 were indeterminate- to high-risk, and 44 were malignant. The mean
ADC differed significantly among those histopathological groups, the value
obtained for the malignant lesions (1.10 × 10-3
mm2/s) being significantly lower than that obtained for the
other groups (p < 0.001). ROC curves demonstrated that DWI performed
better when applied to masses than when applied to non-mass lesions (area
under the curve, 0.88 vs. 0.67). Reproducibility was good (coefficient of
variation, 7.03%; and smallest real difference, ± 0.242 ×
10-3 mm2/s).Conclusion:DWI can differentiate between malignant and nonmalignant (benign or
indeterminate- to high-risk) lesions, showing better performance for masses.
Nevertheless, stratification based on histopathological criteria that are
more refined has yet to be achieved.
RESUMO
Objetivo: Investigar se valores de coeficiente de difusão aparente (ADC) podem discriminar carcinomas ductais in situ (CDIS) de carcinomas invasivos e testar o ganho incremental de modelo combinando tais medidas ao padrão principal de realce (nódulo versus realce não nodular) do estudo contrastado dinâmico (ECD
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