Diffusion‐weighted imaging of breast cancer: Correlation of the apparent diffusion coefficient value with prognostic factors

Abstract

Purpose:To evaluate the role of diffusion-weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors. Materials and Methods:Sixty-seven women with invasive cancer underwent breast MRI. Histological specimens were analyzed for tumor size and grade, and expression of estrogen receptors (ER), progesterone receptors, c-erbB-2, p53, Ki-67, and epidermal growth factor receptors. The computed mean ADC values of breast cancer and normal breast parenchyma were compared. Relationships between the ADC values and prognostic factors were determined using Wilcoxon signed rank test and Kruskal-Wallis test.Results: DWI detected breast cancer as a hyperintense area in 62 patients (92.5 %). A statistically significant difference in the mean ADC values of breast cancer (1.09 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) and normal parenchyma (1.59 Ϯ 0.27 ϫ 10 Ϫ5 mm 2 /s) was detected (P Ͻ 0.0001). There were no correlations between the ADC value and prognostic factors. However, the median ADC value was lower in the ER-positive group than the ER negative group, and this difference was marginally significant (1.09 ϫ 10 Ϫ5 mm 2 /s versus 1.15 ϫ 10 Ϫ5 mm 2 /s, P ϭ 0.053). Conclusion:The ADC value was a helpful parameter in detecting malignant breast tumors, but ADC value could not predict patient prognosis. DYNAMIC CONTRAST MATERIAL-enhanced MRI, which gives information on morphology and kinetics and has higher sensitivity, is frequently used to identify additional lesions and to determine the extent of tumor before surgery (1). In recent years, some studies have attempted to differentiate between benign and malignant tumors using diffusion-weighted imaging (DWI) (2-9). DWI is a specific modality that visualizes the microstructural characteristics of water diffusion in biological tissues. The microscopic motion includes the molecular diffusion of water and blood microcirculation in capillary networks; therefore, both diffusion and perfusion affect apparent diffusion coefficient (ADC) values (2,10). The ADC value was determined to be lower in cancer compared with normal parenchyme or benign breast tumor (2-9). Many studies have attempted to predict treatment response and prognosis in patients with breast cancer. It has been disclosed that there are traditional prognostic factors such as tumor grade and molecular markers such as estrogen receptors (ER) and progesterone receptors (PR) (11). Of these prognostic factors, the histologic grade of the tumor and the Ki-67 proliferation index reflect the cellularity (5,8,12,13), and c-erbB-2 and ER are thought to be associated with perfusion (14,15). We have speculated that these prognostic factors can affect the ADC value.To our knowledge, no studies have examined the correlation between the ADC value and prognostic factors. The objectives of the current study are to examine the clinical usefulness of DWI for the detection of invasive cancer, and to determine whether the ADC value can be a new prognostic factor for patients with...

Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer

“…Breast MRI is an established supplemental technique to mammography and ultrasonography for evaluation of suspicious breast lesions. Diffusion-weighted MRI (DWI) has recently been integrated into the standard breast MRI for discrimination of benign and malignant breast lesions obtained with dynamic contrast-enhanced MRI [1][2][3][4][5][6][7][8][9][10][11][12][13]. DWI is a non-invasive technique that represents the biological character of the mainly Brownian movement of protons in bulk water molecules in vivo.…”

“…Classic prognostic markers, including tumour size and grade, and lymph node status in patients with breast cancer, and molecular markers, including oestrogen receptor (ER), progesterone receptor (PR), index, human growth factor receptor 2 (HER2) protein and angiogenic molecular markers, have been reported [1,15,16]. Few studies have examined the correlation between ADC values and prognostic factors [1,8]. The purpose of this study is to compare ADC values of DWI of breast cancer with prognostic factors.…”

MRI in the differential diagnosis of primary architectural distortion detected by mammography

“…This finding is not consistent with that of a previous study by Tozaki et al (36) who found that segmental distribution, heterogeneous internal enhancement, and clustered ring enhancement were the most frequent findings in malignant NME. Some specific tumor subtypes, such as papillary carcinoma, are associated with the lowest ADC values among malignant breast tumors (37). On the other hand, their ADC values are very similar to those observed for benign papillomas (38), indicating the histologic similarity between benign and malignant papillary lesions.…”

Diagnostic Significance of Apparent Diffusion Coefficient Values with Diffusion Weighted MRI in Breast Cancer: a Meta-Analysis

“…Under the pathological conditions, the alterations of tissue microenvironment, such as loss of membrane integrity and distribution changes of macromolecule, may change the rates of water molecules diffusion, and finally it may present in the image of DWI (Woodhams et al, 2011). Moreover, ADC value was considered as one of the most important quantitative parameters of DWI to reflect the mobility of water molecules in biological tissues, which has shown to be decreased in various malignancies of different organs (Kim et al, 2009;Padhani et al, 2009). Consequently, DWI with ADC values can be regarded as a useful method in the diagnosis and quantitative measurement of neoplasms.…”

“…DWI, as a modality utilized to assess the microstructural characteristics of water diffusion in biological tissues, has been increasingly applied to evaluation the development of tumors in the body (Koh et al, 2007;Kim et al, 2009). The application of DWI is based on the principle that water molecules could explore tissue structures at a microscopic scale which is surpass the ordinary image resolution in the process of their random diffusion-driven displacements (Le Bihan et al, 2001;Cosottini et al, 2005).…”