title: Differential diagnosis of mammographically and clinically occult breast lesions on diffusion-weighted MRI.
abstract: OBJECTIVE
  To investigate the diagnostic performance of diffusion-weighted imaging (DWI) for mammographically and clinically occult breast lesions.
  
  
  METHODS
  The study included 91 women with 118 breast lesions (91 benign, 12 ductal carcinoma in situ [DCIS], 15 invasive carcinoma) initially detected on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and assigned BI-RADS category 3, 4, or 5. DWI was acquired with b = 0 and 600 s/mm(2). Lesion visibility was assessed on DWI. Apparent diffusion coefficient (ADC) values were compared between malignancies, benign lesions, and normal (no abnormal enhancement on DCE-MRI) breast tissue, and the diagnostic performance of DWI was assessed based on ADC thresholding.
  
  
  RESULTS
  Twenty-four of 27 (89%) malignant and 74/91 (81%) benign lesions were hyperintense on the b = 600 s/mm(2) diffusion-weighted images. Both DCIS (1.33 +/- 0.19 x 10(-3) mm(2)/s) and invasive carcinomas (1.30 +/- 0.27 x 10(-3)mm(2)/s) were lower in ADC than benign lesions (1.71 +/- 0.43 x 10(-3)mm(2)/s; P < 0.001), and each lesion type was lower in ADC than normal tissue (1.90 +/- 0.38 x 10(-3)mm(2)/s, P <or= 0.001). Receiver operating curve (ROC) analysis showed an area under the curve (AUC) of 0.77, and sensitivity = 96%, specificity = 55%, positive predictive value (PPV) = 39%, and negative predictive value (NPV) = 98% for an ADC threshold of 1.60 x 10(-3)mm(2)/s.
  
  
  CONCLUSIONS
  Many mammographically and clinically occult breast carcinomas were visibly hyperintense on diffusion-weighted images, and ADC enabled differentiation from benign lesions. Further studies evaluating DWI while blinded to DCE-MRI are necessary to assess the potential of DWI as a noncontrast breast screening technique.
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington 98109-1023, USA. scp3@u.washington.edu
authors.forename: Savannah C
authors.initials: SC
authors.lastname: Partridge
authors.forename: Wendy B
authors.initials: WB
authors.lastname: Demartini
authors.forename: Brenda F
authors.initials: BF
authors.lastname: Kurland
authors.forename: Peter R
authors.initials: PR
authors.lastname: Eby
authors.forename: Steven W
authors.initials: SW
authors.lastname: White
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D055815:Young Adult