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Fusion of high b-value diffusion-weighted and unenhanced T1-weighted images to diagnose invasive breast cancer: factors associated with false-negative results

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Abstract

Objectives

We sought factors associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast breast magnetic resonance imaging (MRI) using fused high b-value diffusion-weighted imaging (DWI) and unenhanced T1-weighted images (T1WI).

Methods

Between 2018 and 2019, 316 consecutive women (mean age, 54.6 years) with invasive breast cancer who underwent preoperative breast MRI, including fused high b-value DWI and unenhanced T1WI, were retrospectively evaluated. Malignancy confidence ratings of the most suspicious breast lesions evident on fused DWI were derived by two radiologists using a 6-point Likert-type scale. Both clinicopathological and imaging features were analyzed. Multivariate regression analysis was performed to identify factors associated with false-negative DWI results in the diagnosis of invasive breast cancer.

Results

Of the 316 breast cancers, fused DWI yielded 289 (91.5%) true-positive and 27 (8.5%) false-negative results. Multivariate analysis showed that small tumor size (≤ 1 cm) (odds ratio [OR], 5.95; 95% confidence interval [CI], 2.11, 16.81; p = 0.001), presence of calcifications in the tumor (OR, 3.41; 95% CI, 1.27, 9.15; p = 0.015), and a moderate/marked background diffusion signal (ORs, 4.23 and 19.18; 95% CI, 1.31, 13.67 and 6.51, 56.46; p = 0.016 and p < 0.001, respectively) were significantly associated with false-negative results. In subgroup analysis of 141 screening-detected cancers, a marked background diffusion signal (OR, 7.94; 95% CI, 2.30, 27.35; p = 0.001) remained significantly associated with false-negative results in the multivariate analysis.

Conclusions

In addition to histopathological features, a higher background diffusion signal was associated with false-negative results in the diagnosis of invasive breast cancer via non-contrast MRI using fused high b-value DWI and unenhanced T1WI.

Key Points

• Subcentimeter tumors and presence of calcifications in the tumor are associated with false-negative diffusion-weighted imaging results in the diagnosis of invasive breast cancer.

• A higher degree of background diffusion signal may lead to false-negative interpretation of diffusion-weighted imaging in patients with invasive breast cancer.

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Abbreviations

ADC:

Apparent diffusion coefficient

CI:

Confidence interval

DCE:

Dynamic contrast-enhanced

DWI:

Diffusion-weighted imaging

MRI:

Magnetic resonance imaging

OR:

Odds ratio

T1WI:

T1-weighted imaging

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Funding

This study was supported by Biomedical Research Institute Grant (20200228), Pusan National University Hospital.

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Authors and Affiliations

  1. Department of Radiology, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea

    Jin Joo Kim & Jin You Kim

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  1. Jin Joo Kim
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  2. Jin You Kim
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Correspondence to Jin You Kim.

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The scientific guarantor of this publication is Jin You Kim.

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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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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

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• performed at one institution

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Kim, J.J., Kim, J.Y. Fusion of high b-value diffusion-weighted and unenhanced T1-weighted images to diagnose invasive breast cancer: factors associated with false-negative results. Eur Radiol 31, 4860–4871 (2021). https://doi.org/10.1007/s00330-020-07644-5

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  • DOI: https://doi.org/10.1007/s00330-020-07644-5

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