Nonmalignant Breast Lesions: ADCs of Benign and High-Risk Subtypes Assessed as False-Positive at Dynamic Enhanced MR Imaging

Parsian, Sana; Rahbar, Habib; Allison, Kimberly H.; DeMartini, Wendy B.; Olson, Matthew; Lehman, Constance D.; Partridge, Savannah C.

doi:10.1148/radiol.12112672

Cited by 72 publications

(54 citation statements)

References 59 publications

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“…Use of DWI together with T2-weighted images created a good unenhanced imaging alternative to DCE-MRI in lesion detection and characterization. This method was previously used in some experimental clinical and reader studies and found to be useful for the diagnosis of breast cancer (24)(25)(26)(27). Lastly, Trimboli et al (28) reported 78% sensitivity and 87% specificity for breast cancer detection with unenhanced MRI of 67 women.…”

Section: Discussionmentioning

confidence: 98%

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Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

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T he Breast Imaging Reporting and Data Systems (BI-RADS) lexicon (1) of AmericanCollege of Radiology (ACR) provides an efficient and standardized assessment and management of breast lesions. It also stratifies breast cancer risk for a given lesion by classifying them into categories 1 through 5 according to the degree of suspicion.According to this system, solid masses with a circumscribed margin, oval shape (including those with two or three gentle lobulations) and parallel orientation on ultrasonography (US) exam are classified as BI-RADS 3. These types of masses are commonly seen at diagnostic and screening examinations. In this category malignancy is highly unlikely (less than 2%) and a short interval follow-up is recommended (1). However, up to one-third of such masses undergo biopsy mainly because of radiologist, referring clinician, or patient concern about the substantial risk of malignancy (2-4). Many BI-RADS 3 masses are traditionally referred for biopsy if they are palpable, large in size, patient is of advanced age or has a positive family history for breast cancer.The BI-RADS 4 assessment is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy. This category is largely indeterminate and highly variable in outcome. Breast lesions in this category carry 2% to 95% risk for malignancy (1). Thus, almost all recommendations for breast biopsies come from assessments made using this category. According to BI-RADS classification; category 4 is subgrouped as 4A, 4B, and 4C to better inform the clinicians, pathologists, and patients of the degree of concern. However, the criteria for distinguishing among these subcategories have not been well delineated. BI-RADS 4A designates lesions with a low suspicion for malignancy. In this group, a benign pathologic diagnosis is expected and considered concordant (1). Studies of several institutions by the use of their internal criteria revealed positive predictive value (PPV) of 7%-9% for 4A lesions, and more than 50% of the suspicious lesions fall into this category. On the other hand, BI-RADS 4B and 4C 287From the Department of Radiology (S.K.  sibel_ozy@ yahoo.com) Karadeniz Technical University, School of Medicine, Trabzon, Turkey. BREAST IMAGING ORIGINAL ARTICLE PURPOSE We aimed to determine whether low-risk breast masses can be effectively managed with unenhanced magnetic resonance imaging (MRI) combining T2-weighted sequences with diffusion-weighted imaging (DWI) instead of immediate biopsy to decrease negative biopsy rates. METHODSAfter institutional review board and patient approvals, 141 consecutive women with 156 low-risk breast masses, who underwent unenhanced MRI and later on received a final diagnosis, were included in the study. There were 72 BI-RADS 3 masses in women with relative risk factors and 84 BI-RADS 4A masses, all referred for biopsy. Apparent diffusion coefficient (ADC) cutoff was 0.90×10-3 mm2/s. According to ADC values and T2-weighted imaging charact...

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Section: Discussionmentioning

confidence: 98%

“…High T2 signal can help diagnose active fibroadenomas most of the time. Fibroadenoma is most common diagnosis in low-risk breast masses and most prevalent lesion type that shows high ADC values (27). However, an uncommon malignancy of elderly women (mucinous cancers) also shows bright signal on T2-weighted images and can cause misdiagnosis.…”

Section: Discussionmentioning

confidence: 99%

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Kul

Oguz²,

Eyüboğlu³

et al. 2015

Diagn Interv Radiol

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“…Combined with DCE, DWI scans have significantly elevated the specificity and accuracy in the diagnosis of breast cancer compared with DCE-MRI alone. 4,6 Based on DWI, diffusion tensor imaging (DTI) could detect more information about the microstructure. 7 DTI could provide not only the average apparent diffusion coefficient (ADC), but also three-dimensional anisotropy diffusion parameters such as fractional anisotropy (FA).…”

Section: Introductionmentioning

confidence: 99%

Diffusion tensor imaging of breast lesions: evaluation of apparent diffusion coefficient and fractional anisotropy and tissue cellularity

Jiang

Hua

et al. 2016

BJR

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“…The cutoff value of ADC to differentiate between benign and malignant lesions as per this study was 1.81x10 -3 mm 2 /s. Sana Parsian et al, (6) Table 7.3: Table comparing validity paramaters of present and previous study for a sensitivity of 100% F Kelcz et al, (7) in a study evaluating cases of post lumpectomy irradiated breast have found a mean ADC value of 1.89 ( range 1.43-2.20). These findings are well correlating with our studythere were 6 cases, all of which showed unrestricted diffusion.…”

Section: Diffusion Weighted Imaging and Adc Valuementioning

confidence: 60%

Imaging of Breast Lesions Using Conventional Magnetic Resonance Imaging and Diffusion Weighted Imaging

Menon¹,

Rajendran²,

Lakshmanan³

et al. 2015

jemds

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CONTEXT: Breast cancer is the second most common cancer in the world, and the second most common in cancer in Indian women. AIMS: The aims of this study were to differentiate between benign and malignant lesions using Diffusion Weighted Imaging, T2-weighted and T1-weighted imaging, and to set a cut off value of ADC to differentiate between benign and malignant lesions. MATERIALS AND METHODS: It included 51 patients between the ages of 15 and 75 years, coming to surgical OPD, Government Medical College, Kozhikode with USG/Mammogram proven breast lesions from January 2013 to September 2014. Non contrast MR Mammography was done using 1.5 T MR system. T1WI, T2WI and Diffusion weighted imaging (b= 0, 600) were done and ADC values were calculated for all the lesions. Validity parameters were assessed for each sequence and a combination of all the sequences. ROC curve was plotted and ADC cut off was chosen with a high sensitivity and specificity. RESULTS: Twenty nine lesions were categorized as benign and twenty two lesions were categorized as malignant based on the T1, T2 and DWI. By histopathological examination of these lesions, 2 lesions characterised as malignant turned out to be benign.T1WI was not found to be helpful in differentiating between benign and malignant lesions, whereas 95% of malignant lesions appeared either intermediate signal (90%) or hypointense (5%) in T2WI, conferring a sensitivity of 90.5% and specificity of 80.6% in detection of malignant lesions using T2WI. Applying an ADC threshold of 1.255×10 −3 mm2/s benign and malignant lesions could be differentiated with 100% sensitivity and 93.5% specificity, with a PPV of 90.9% and NPV of 100%. Mean ADC value of malignant lesions was found to be 1.13±0.007 mm 2 /s. CONCLUSION: Non contrast MRI using T2WI and DWI is a useful technique for characterizing breast lesions. It is also useful in the follow up of post lumpectomy irradiated breast to detect recurrence.

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Nonmalignant Breast Lesions: ADCs of Benign and High-Risk Subtypes Assessed as False-Positive at Dynamic Enhanced MR Imaging

Cited by 72 publications

References 59 publications

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Can unenhanced breast MRI be used to decrease negative biopsy rates?

Diffusion tensor imaging of breast lesions: evaluation of apparent diffusion coefficient and fractional anisotropy and tissue cellularity

Imaging of Breast Lesions Using Conventional Magnetic Resonance Imaging and Diffusion Weighted Imaging

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