Differentiation of malignant and benign breast lesions: Added value of the qualitative analysis of breast lesions on diffusion-weighted imaging (DWI) using readout-segmented echo-planar imaging at 3.0 T

Abstract

ObjectiveTo determine the added value of qualitative analysis as an adjunct to quantitative analysis for the discrimination of benign and malignant lesions in patients with breast cancer using diffusion-weighted imaging (DWI) with readout-segmented echo-planar imaging (rs-EPI).MethodsA total of 99 patients with 144 lesions were reviewed from our prospectively collected database. DWI data were obtained using rs-EPI acquired at 3.0 T. The diagnostic performances of DWI in the qualitative, quantitative, and combination analyses were compared with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Additionally, the effect of lesion size on the diagnostic performance of the DWI combination analysis was evaluated.ResultsThe strongest indicators of malignancy on DWI were a heterogeneous pattern (P = 0.005) and an apparent diffusion coefficient (ADC) value <1.0 × 10–3 mm2/sec (P = 0.002). The area under the curve (AUC) values for the qualitative analysis, quantitative analysis, and combination analysis on DWI were 0.732 (95% CI, 0.651–0.803), 0.780 (95% CI, 0.703–0.846), and 0.826 (95% CI, 0.754–0.885), respectively (P<0.0001). The AUC for the combination analysis on DWI was superior to that for DCE-MRI alone (0.651, P = 0.003) but inferior to that for DCE-MRI plus the ADC value (0.883, P = 0.03). For the DWI combination analysis, the sensitivity was significantly lower in the size ≤1 cm group than in the size >1 cm group (80% vs. 95.6%, P = 0.034).ConclusionsQualitative analysis of tumor morphology was diagnostically applicable on DWI using rs-EPI. This qualitative analysis adds value to quantitative analyses for lesion characterization in patients with breast cancer.

Evaluation of Breast Cancer Morphology Using Diffusion‐Weighted and Dynamic Contrast‐Enhanced MRI: Intermethod and Interobserver Agreement

“…Thus far, only a few studies pertaining to DWI have addressed its potential for morphological analysis of breast lesions . Kang et al analyzed the diagnostic accuracy of high peripheral DWI signal in breast lesions, the "rim sign," and reported sensitivity, specificity, and area under the curve (AUC) values equaling 59.7%, 80.6%, and 0.701, respectively .…”

“…The investigators also observed higher AUC values based on the BI‐RADS score for rFOV DWI than for bilateral DWI and suggested the additional information on tumor morphology provided by rFOV DWI could have contributed to the increase. Recently, a more comprehensive analysis was provided by An et al, who compared the diagnostic performances of DWI in the qualitative, quantitative, and combination analyses with that of DCE MRI . Lesions were subjected to qualitative DWI analysis using multiple morphological descriptors contained in the current BI‐RADS lexicon edition.…”

“…18,19,21 Thus far, only a few studies pertaining to DWI have addressed its potential for morphological analysis of breast lesions. [22][23][24] Kang et al analyzed the diagnostic accuracy of high peripheral DWI signal in breast lesions, the "rim sign," and reported sensitivity, specificity, and area under the curve (AUC) values equaling 59.7%, 80.6%, and 0.701, respectively. 22 They concluded that DWI high-signal rim sign was useful for improving the specificity of DWI to differentiate between benign and malignant lesions.…”

“…Recently, a more comprehensive analysis was provided by An et al, who compared the diagnostic performances of DWI in the qualitative, quantitative, and combination analyses with that of DCE MRI. 24 Lesions were subjected to qualitative DWI analysis using multiple morphological descriptors contained in the current BI-RADS lexicon edition. AUC values for the qualitative, quantitative, and combination analysis on DWI were 0.732, 0.780, and 0.826, respectively.…”

Dynamic MR Evaluation of Breast Lesions: A Single Centre Prospective Study

“…As shown in figure 5 and 6 A, B, C&D there was no central enhancement lesion in the present study. 16.2% of the lesions showed dark non enhancing internal septations that are mostly benign type. The least number of lesions are homogeneous types (fig-5).…”