Quantitative apparent diffusion coefficient measurement obtained by 3.0Tesla MRI as a potential noninvasive marker of tumor aggressiveness in breast cancer

Abstract

Purpose To assess the association between apparent diffusion coefficient (ADC), and histological prognostic parameters in malignant breast lesions. The ability of ADC to identify lesions with the presence of Lymphovascular invasion (LVI) in breast carcinoma was also examined. Materials and Methods This HIPAA-compliant retrospective study consisted of 212 consecutive patients with known cancers who underwent 3.0T MRI between January 2011 and 2013. In this study, a total of 126 malignant lesions in 114 women, who had undergone DWI (b-values of 0 and 1000 s/mm2) in addition to diagnostic MRI, were included. Patients with less than 0.8 cm lesions, or those who underwent neoadjuvant chemotherapy or suboptimal DW images were excluded. Classical prognostic factors [lesion size, histopathological type and grade, lymph node (LN) status and lymphovascular invasion (LVI)], molecular prognostic markers [estrogen receptor (ER), progesterone receptor (PR) and human epidermal grow factor receptor 2(HER2)] were reviewed and recorded. A region of interest (ROI) was drawn within the lesions to measure ADC values. Statistical analyses were performed by the Wilcoxon rank sum test (statistical significance at P<0.05). Adjusted p values from multiple comparison analysis were also calculated. Results This study demonstrates an inverse correlation between ADC and LVI in malignant lesions and the ability of ADC to identify aggressiveness in lesions with positive LVI. Tumor size, grade, ER, PR, HER2 and lymph node status did not impact tumor ADC value. However, tumors with LVI showed significantly lower ADC values when compared to tumors without LVI, regardless of the enhancement type, histological grade, histological type, and LN status. Conclusion Our study shows that ADC could be a potential clinical adjunct in the evaluation of prognostic factors related to malignant lesion aggressiveness such as LVI.

Apparent diffusion coefficient in estrogen receptor‐positive and lymph node‐negative invasive breast cancers at 3.0T DW‐MRI: A potential predictor for an oncotype Dx test recurrence score

“…Several studies have evaluated ADC as a potential prognostic factor by analyzing its relationship with traditional and molecular prognostic factors, although the impact of ADC on prognosis still needs to be validated. Recently, Rabasco et al investigated the correlation between ADC in breast cancer and the presence of distant metastases at 3 years, suggesting that ADC values may represent a significant prognostic factor.…”

Correlation between minimum apparent diffusion coefficient values and the histological grade of breast invasive ductal carcinoma

“…Cipolla et al (16) also revealed that the ADC values were significantly higher in G1 tumors as compared with G3 tumors, while there was no statistically significant difference upon comparison of G1 and G3 tumors with G2 tumors. By contrast, several other studies have indicated that no correlation exists between the ADC value and tumor grade (17)(18)(19)(20).…”

“…The majority of previous studies (13)(14)(15)(16)(17)(18)(19)(20) have used the mean ADC value when investigating its correlation with the tumor grade. However, in the present study, the ADC min values were used instead, and significant differences were observed in these values between different tumor grades.…”

“…Byun et al (27) have measured the mean ADC and the mean ADC min values in the regions with the highest fluorodeoxyglucose (FDG) uptake using sequential 18 F-FDG positron-emission tomography and MRI, and examined the correlation of the corresponding ADC values with the histological grade of IDC. The majority of these aforementioned studies have applied the multiple ROI method in breast MRI, and the ADC min value represented the lowest mean ADC value among multiple small ROIs within the lesion.…”

“…The association between DWI and the histolog-). The association between DWI and the histological grade of IDC has also been reported, although differential findings have been observed due to the use of a different region of interest (ROI) and measurement methods (13)(14)(15)(16)(17)(18)(19)(20). The majority of previous studies have applied the mean ADC value to indicate the pathological characteristics of tumors.…”