Abstract
Objectives
To investigate whether diffusion-weighted imaging (DWI) aids pre-operative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate additional lesions in breast cancer patients.
Methods
DCE-MRI and DWI were performed on 131 lesions, with available histopathological results. The apparent diffusion coefficient (ADC) of each lesion was measured, and the cut-off value for differentiation between malignant and benign lesions was calculated. A protocol combining the ADC cut-off value with DCE-MRI was validated in a cohort of 107 lesions in 77 patients.
Results
When an ADC cut-off value of 1.11 × 10-3 mm2/s from the development cohort was applied to the additional lesions in the validation cohort, the specificity increased from 18.9% to 67.6% (P < 0.001), and the diagnostic accuracy increased from 61.7% to 82.2% (P = 0.05), without significant loss of sensitivity (98.6% vs. 90.0%, P = 0.07). The negative predictive values of lesions in the same quadrant had decreased, as had those of lesions ≥1 cm in diameter. The ADC cut-off value in the validation cohort was 1.05 × 10-3 mm2/s.
Conclusions
Additional implementation of DWI for breast lesions in pre-operative MRI can help to obviate unnecessary biopsies by increasing specificity. However, to avoid missing cancers, clinicians should closely monitor lesions located in the same quadrant or lesions ≥1 cm.
Key Points
• DWI can be used to further differentiate lesions during pre-operative cancer staging.
• ADC cut-off values were similar in the development and validation cohorts.
• DWI improves both PPV and NPV in cases of multicentric lesions.
• DWI improves both PPV and NPV in lesions <1 in diameter.
• NPVs are decreased in multifocal lesions and lesions ≥1 cm in diameter.
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The scientific guarantor of this publication is Kyu Ran Cho.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
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Statistics and biometry
No complex statistical methods were necessary for this paper.
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Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Methodology
• prospective
• observational
• performed at one institution
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Sung Eun Song and Eun Kyung Park contributed equally to this work.
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Song, S.E., Park, E.K., Cho, K.R. et al. Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using pre-operative breast MRI. Eur Radiol 27, 4819–4827 (2017). https://doi.org/10.1007/s00330-017-4898-5
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DOI: https://doi.org/10.1007/s00330-017-4898-5