Diffusion-weighted imaging of suspicious (BI-RADS 4) breast lesions: stratification based on histopathology

Abstract

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.

DCE-MRI-Derived Volume Transfer Constant (Ktrans) and DWI Apparent Diffusion Coefficient as Predictive Markers of Short- and Long-Term Efficacy of Chemoradiotherapy in Patients With Esophageal Cancer

“…Diffusion-weighted imaging is able to differentiate between malignant and nonmalignant lesions, exhibiting a better performance for mass evaluation. 34 Furthermore, reports have indicated that ADC obtained from DWI is capable of acting as a biomarker in the evaluation of early responses to treatment in various forms of cancer. 35 Consistent with clinical literature, during our study, a significant change in tumor ADC values was observed following chemoradiotherapy treatment, which we considered as being positive response to therapy.…”

Multiparameter MRI Model With DCE-MRI, DWI, and Synthetic MRI Improves the Diagnostic Performance of BI-RADS 4 Lesions

“…Diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and other quantitative imaging techniques in diagnosing breast BI-RADS 3-5 lesions have been explored extensively to aid in diagnosis specificity. Relaxation time could be another quantitative MR method for the diagnosis of breast diseases (9)(10)(11)(12)(13)(14)(15). Previous studies have shown that quantitative longitudinal relaxation time (T1) and transverse relaxation time (T2) values could assess the histopathology of breast diseases and, thus, be used as a potential biomarker of biopsy (16,17).…”