Limited role of DWI with apparent diffusion coefficient mapping in breast lesions presenting as non-mass enhancement on dynamic contrast-enhanced MRI Journal Article

   

Authors:	Avendano, D.; Marino, M. A.; Leithner, D.; Thakur, S.; Bernard-Davila, B.; Martinez, D. F.; Helbich, T. H.; Morris, E. A.; Jochelson, M. S.; Baltzer, P. A. T.; Clauser, P.; Kapetas, P.; Pinker, K.
Article Title:	Limited role of DWI with apparent diffusion coefficient mapping in breast lesions presenting as non-mass enhancement on dynamic contrast-enhanced MRI
Abstract:	Background: Available data proving the value of DWI for breast cancer diagnosis is mainly for enhancing masses; DWI may be less sensitive and specific in non-mass enhancement (NME) lesions. The objective of this study was to assess the diagnostic accuracy of DWI using different ROI measurement approaches and ADC metrics in breast lesions presenting as NME lesions on dynamic contrast-enhanced (DCE) MRI. Methods: In this retrospective study, 95 patients who underwent multiparametric MRI with DCE and DWI from September 2007 to July 2013 and who were diagnosed with a suspicious NME (BI-RADS 4/5) were included. Twenty-nine patients were excluded for lesion non-visibility on DWI (n = 24: 12 benign and 12 malignant) and poor DWI quality (n = 5: 1 benign and 4 malignant). Two readers independently assessed DWI and DCE-MRI findings in two separate randomized readings using different ADC metrics and ROI approaches. NME lesions were classified as either benign (> 1.3 × 10-3 mm2/s) or malignant (≤ 1.3 × 10-3 mm2/s). Histopathology was the standard of reference. ROC curves were plotted, and AUCs were determined. Concordance correlation coefficient (CCC) was measured. Results: There were 39 malignant (59%) and 27 benign (41%) lesions in 66 (65 women, 1 man) patients (mean age, 51.8 years). The mean ADC value of the darkest part of the tumor (Dptu) achieved the highest diagnostic accuracy, with AUCs of up to 0.71. Inter-reader agreement was highest with Dptu ADC max (CCC 0.42) and lowest with the point tumor (Ptu) ADC min (CCC = - 0.01). Intra-reader agreement was highest with Wtu ADC mean (CCC = 0.44 for reader 1, 0.41 for reader 2), but this was not associated with the highest diagnostic accuracy. Conclusions: Diagnostic accuracy of DWI with ADC mapping is limited in NME lesions. Thirty-one percent of lesions presenting as NME on DCE-MRI could not be evaluated with DWI, and therefore, DCE-MRI remains indispensable. Best results were achieved using Dptu 2D ROI measurement and ADC mean. © 2019 The Author(s).
Keywords:	adult; aged; major clinical study; histopathology; area under the curve; magnetic resonance imaging; diagnostic accuracy; breast cancer; retrospective study; correlation coefficient; image quality; breast tumor; breast carcinoma; reliability; gynecomastia; dynamic contrast-enhanced magnetic resonance imaging; diffusion weighted imaging; intraductal carcinoma; receiver operating characteristic; breast fibroadenoma; breast hyperplasia; breast fibrosis; breast papilloma; diagnostic test accuracy study; diffusion-weighted imaging; fat necrosis; lobular carcinoma; apparent diffusion coefficient; concordance correlation coefficient; human; male; female; article; measurement repeatability; breast abscess; non-mass enhancement; fibroadenomatoid hyperplasia; inter reader agreement; intra reader agreement
Journal Title:	Breast Cancer Research
Volume:	21
ISSN:	1465-5411
Publisher:	Biomed Central Ltd
Date Published:	2019-12-04
Start Page:	136
Language:	English
DOI:	10.1186/s13058-019-1208-y
PUBMED:	31801635
PROVIDER:	scopus
PMCID:	PMC6894318
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85075980126&doi=10.1186%2fs13058-019-1208-y&partnerID=40&md5=b5257e569a9d07842b7cd001945673bc
Notes:	Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/157543