The role of diffusion weighted imaging as supplement to dynamic contrast enhanced breast MRI: Can it help predict malignancy, histologic grade and recurrence?

Autor: Michael D.C. Fishman, Alexander Brook, Shima Roknsharifi, Monica D. Agarwal, Vritti Kharbanda, Vandana Dialani
Rok vydání: 2018
Předmět:
Adult
medicine.medical_specialty
Receptor
ErbB-2
Contrast Media
Breast Neoplasms
Malignancy
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
Breast cancer
Predictive Value of Tests
medicine
Breast MRI
Effective diffusion coefficient
Mucinous carcinoma
Humans
Radiology
Nuclear Medicine and imaging
skin and connective tissue diseases
Retrospective Studies
medicine.diagnostic_test
business.industry
Carcinoma
Ductal
Breast
Ductal carcinoma
Middle Aged
medicine.disease
Adenocarcinoma
Mucinous
Magnetic Resonance Imaging
Neoplasms
Complex and Mixed
body regions
Carcinoma
Lobular
Carcinoma
Intraductal
Noninfiltrating
Diffusion Magnetic Resonance Imaging
Receptors
Estrogen
030220 oncology & carcinogenesis
Invasive lobular carcinoma
Female
Radiology
Neoplasm Grading
Neoplasm Recurrence
Local
business
Oncotype DX
Receptors
Progesterone
Zdroj: Academic radiology. 26(7)
ISSN: 1878-4046
Popis: Rationale and Objectives To evaluate the value of adding Diffusion Weighted Imaging (DWI) with Apparent Diffusion Coefficient (ADC) mapping to dynamic contrast enhanced (DCE-MRI) to distinguish benign from malignant pathology subtypes and tumor recurrence. Method and Materials In this retrospective IRB approved study, 956 consecutive patients underwent bilateral breast MRI between 1/2015 and 12/2015, with 156 BIRADS 4, 5, or 6 lesions detected in 111 patients. DWI imaging at B0, B100, B600, B1000 was performed with DCE-MRI. Values for diffusion and ADC images were recorded by two fellowship-trained breast radiologists. Mean ADC and signal intensity (SI) values were correlated with histology, tumor grade, hormone receptors (ER, PR, and HER-2)and Oncotype DX scores, when available. p ≤ 0.05 was considered significant. Results Of 156 lesions, there were 59 (38%) benign lesions, 24 (15%) Ductal Carcinoma In-Situ, 47 (30%) Invasive Ductal Carcinoma (IDC), 15 (10%) Invasive Lobular Carcinoma (ILC) and 2 (2%) Mucinous carcinoma (MC), five (5%) mixed IDC and ILC, and four (4%) other, including tubular and rare types of malignancy. Mean ADC values for malignancy were significantly lower than for benign lesions (1085 ± 343 × 10−6 vs 1481 ± 276 × 10−6 mm2/s), which is highly predictive (area under curve = 0.82). In addition, tumors with PR negativity and Oncotype score ≥18 (intermediate to high risk for recurrence) demonstrated significantly lower ADC values. SI at B100 and B600 was helpful in distinguishing benign versus IDC. There was no significant correlation between ADC values and tumor grade or ER/HER2 status. Conclusion ADC value is important factor in distinguishing malignancy, differentiating tumors with higher Oncotype score, and PR negativity. Therefore, it can be used as an important tool to assist appropriate treatment selection.
Databáze: OpenAIRE
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