Apparent Diffusion Coefficients of Breast Tumors: Clinical Application

Abstract

Purpose: To evaluate the usefulness of apparent diŠusion coe‹cient (ADC) for the diŠerential diagnosis of breast tumors and to determine the relation between ADC and tumor cellularity.Materials and Methods: One hundred and thirty-six female patients (age range, 17-83 years; average age, 51.7 years) with 140 histologically proven breast tumors underwent diŠusion-weighted magnetic resonance (MR) imaging (DWI) using the spin-echo echo-planar technique, and the ADCs of the tumors were calculated using 3 diŠerent b values, 0, 500, and 1000 s/mm 2 . The diagnoses consisted ofˆbroadenoma (FA, n＝16), invasive ductal carcinoma, not otherwise speciˆed (IDC, n＝117), medullary carcinoma (ME, n＝3) and mucinous carcinoma (MU, n＝4). Tumor cellularity was calculated from surgical specimens. The ADCs of breast tumors and cellularity were compared between diŠerent histological types by analysis of variance and ScheŠe's post hoc test. The correlation between tumor cellularity and ADC was analyzed by Pearson correlation test.Results: Signiˆcant diŠerences were observed in ADCs between FA and all types of cancers (Pº0.05) and between MU and other types of cancers (Pº0.01) and in cellularity between FA and cancers except MU (Pº0.01) and between MU and other types of cancers (Pº0.01). There was an inverse correlation between ADC and tumor cellularity (Pº0.01, r 2 ＝0.451).Conclusions: The ADC may potentially help in diŠerentiating benign and malignant breast tumors. Tumor ADC correlates inversely with tumor cellularity.

Quantitative diffusion weighted imaging for differentiation of benign and malignant breast lesions: The influence of the choice of b‐values

“…The benign lesions in our study consisted of eight different types of lesions and the invasive carcinomas of four different types. Hatakenaka et al showed that there was a significant difference between the ADC of mucinous carcinoma and other types of malignant breast lesions (11). Perhaps there is more heterogeneity within each category of breast lesions (benign, noninvasive, and invasive lesions) than was previously acknowledged.…”

“…Many studies report absolute threshold ADC values to differentiate benign and malignant lesions (6,7,(11)(12)(13)(14). However, all authors recommended other threshold ADC values, ranging from 1.10Á10 À3 to 1.60Á10 À3 mm 2 /s.…”

“…Many different strategies have been proposed to increase the specificity such as calculating pharmacokinetic contrast parameters (4), T2*-weighted perfusion imaging (5) and MR spectroscopy (5). A promising adjunct MRI technique is diffusion-weighted imaging (DWI) (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). In DCE Breast MRI, lesions are characterized based on morphology, internal enhancement, and kinetic enhancement pattern (16,17).…”

“…Reported absolute ADC threshold values range from 1.10Á10 À3 to 1.60Á10 À3 mm 2 /s (6,7,(11)(12)(13). This variability can be attributed to several factors, including variation in physiological characteristics of the lesions, the use of different scan techniques, and variation in image analysis for ADC calculation.…”

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions

“…In recent years, diffusion-weighted imaging (DWI), albeit not routinely used as a part of breast MRI protocol, with the implementation of ultrafast MRI sequences contributes to the evaluation of breast lesions (15)(16)(17). The principle of the DWI is related to the Brownian movement of the water particles, which is restricted due to structure of the environment depending on the cellularity degree of the lesions (18,19).…”