Diagnostic Value of Diffusion-weighted Imaging and Apparent Diffusion Coefficient Values in the Differentiation of Breast Lesions, Histpathologic Subgroups and Correlatıon with Prognostıc Factors using 3.0 Tesla MR

Abstract

IntroductionMagnetic resonance imaging (MRI) as a method for breast exams has been used increasingly frequently during the last decade. In particular, it is preferred for selected cases as a diagnostic and problem-solving method for its high contrast resolution, multiplanar capability of examination, lack of ionizing radiation, and capacity to obtain dynamic contrast images (1, 2). Conventional MRI has disadvantages such as time-consuming screening and requirement of high-value contrast agents (3). Despite the fact that dynamic contrast-enhanced MRI is an efficient diagnostic exam with high sensitivity, but its limited specificity creates a need for new techniques (1-7). Therefore, additional sequences are sought that would increase image quality, reduce imaging time and enable differential diagnosis for lesions (4). Diffusionweighted imaging (DWI) is one of these fast MRI sequences. By recording the free movement of water molecules in the extracellular space, DWI creates different signals in images as a result of the inhibition of this movement and therefore diffusion restriction, which occurs due to an increase in cell frequency in the presence of a malignant mass. The apparent diffusion coefficient (ADC) is a quantitative measure of the diffusion of water molecules within tissue. Using the data in various b-values obtained from DWI in MRI, ADC maps are created and ADC values of lesions can be calculated (8,9). Recent studies showed that DWI and ADC measurements had high rates of accuracy and specificity in the differential diagnosis of malignant and benign breast lesions (10-13).Breast cancer is a heterogeneous disease, and its natural course after diagnosis varies among patients. In the follow-up of patients with tumors of the same diameter, some experience tumor recurrence after a very short time, whereas others continue living a healthy life. Therefore, prognostic factors and molecular subgroups are used in order to determine differences between clinical and biologic behaviors of patients with breast cancer and establish the high-risk group, which demonstrates a quick disease progression (14-17). Although some of these factors (tumor diameter, axillary involvement, histologic characteristics of tumor, hormone receptors) have a well-known role in determining prognosis, there is ongoing intensive research regarding hormone receptors, tumor proliferation rate, and molecular prog- Breast Health 2016; 12: 123-132 DOI: 10.5152/tjbh.2016 12: 123-132 DOI: 10.5152/tjbh. .2897 123 ABSTRACT Objective: The aim of this study was to evaluate the effect of the apparent diffusion coefficient (ADC) and diffusion-weighted imaging in differentiating benign from malignant breast lesions, histopathologic subtypes of breast tumors, and to find a correlation with prognostic factors using 3T MR. Materials and Methods:A total of 165 patients aged between 16 and 78 years with 181 histopathologically-verifed breast lesions were enrolled in this study. A 3T MR system and bilateral phased array breast coil was used. Diffusion-weigh...

Diffusion weighted magnetic resonance imaging (DW-MRI) as a non-invasive, tissue cellularity marker to monitor cancer treatment response

“…Studies in different types of cancer have also proposed DW-MRI as a marker to distinguish benign and malignant tumors and to evaluate the aggressiveness of cancer based on ADC-values, but that goes beyond the scope of the present study [36][37][38][39][40].…”

Whole Volume Apparent Diffusion Coefficient (ADC) Histogram as a Quantitative Imaging Biomarker to Differentiate Breast Lesions: Correlation with the Ki-67 Proliferation Index

“…In addition, the whole volume ADC histogram could supply more information and predict Ki-67 more accurately than a single ADC value. Some studies analysed the associations between the ADC value and the expression of Ki-67 in breast cancer [ 7 , 18 , 19 ] with different ROI placements; however, data about the relationships between the Ki-67 index and ADC value were inconsistent. Mori et al reported that there was a moderately significant correlation between the whole tumour ADC histogram (ADC-mean) and Ki-67 [ 13 ].…”

“…However, Surov et al found only a weak negative correlation between these two parameters [ 18 ]. Some studies found that there were no statistically significant correlations between the ADC value and Ki-67 [ 7 , 19 ]. Overall, the possibility of using ADC as an imaging marker for proliferation activity in breast cancer is uncertain in clinical practice.…”

Can diffusion-weighted imaging predict tumor grade and expression of Ki-67 in breast cancer? A multicenter analysis

“…However, Aydin et al could find only a weak negative correlation between ADC and Ki-67-values in BC ( r = − 0.279; p = 0.029) [ 10 ]. Finally, some authors did not identify statistically significant correlations between these parameters [ 11 – 13 ]. Similarly, data about relationships between tumor grade and ADC were also inconsistent.…”