title: Diagnostic performance of ADC for Non-mass-like breast lesions on MR imaging.
abstract: We assessed the usefulness and limitations of utilizing apparent diffusion coefficient (ADC) values on diffusion-weighted imaging (DWI) for the differential diagnosis of benign and malignant non-mass-like breast lesions. We retrospectively reviewed 27 such lesions (16 malignant, 11 benign) detected on magnetic resonance (MR) imaging and analyzed the enhancing patterns of dynamic contrast-enhanced DCE-MRI (distribution and internal enhancement), kinetic curve patterns, and ADC values. All images were obtained with a 1.5-tesla MR unit, with patients supine. On DCE-MRI, malignant lesions tended to show either segmental or branching-ductal distribution, and when lesions with these patterns were considered malignant, sensitivity was 68.8%; specificity, 63.6%; positive predictive value (PPV), 73.3%; negative predictive value (NPV), 58.3%; and accuracy, 66.7%. Kinetic curve analysis did not reliably differentiate benign and malignant non-mass-like lesions. There was no significant difference between the mean ADC value of the malignant lesions, 0.968 × 10(-3) mm(2)/s at b=1000 s/mm(2), and that of benign lesions, 1.207 × 10(-3) mm(2)/s (P=0.109). Receiver operating characteristic (ROC) analysis revealed the most effective threshold of ADC value for differentiating tumors as 1.1 × 10(-3) mm(2)/s; values lower than this were observed more often in malignant than benign lesions (P=0.054). Us of this threshold yielded sensitivity of 68.8%; specificity, 72.7%; PPV, 78.6%; NPV, 61.5%; and accuracy, 70.4%. Combining the ADC value criteria with the analysis of DCE-MRI pattern increased sensitivity to 93.8%, negative predictive value (NPV) to 85.7%, and accuracy to 77.8% but decreased specificity to 54.5%. Use of ADC values does not adequately improve DCE-MRI performance for differential diagnosis of non-mass-like breast lesions, but adding the ADC value criteria to the DCE-MRI pattern analysis improves sensitivity, NPV, and accuracy.
authors.affiliation: Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan. tsuguteao330@yahoo.co.jp
authors.forename: Tsugumi
authors.initials: T
authors.lastname: Imamura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Isomoto
authors.forename: Eijun
authors.initials: E
authors.lastname: Sueyoshi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yano
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Uga
authors.forename: Kuniko
authors.initials: K
authors.lastname: Abe
authors.forename: Tomayoshi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Sumihisa
authors.initials: S
authors.lastname: Honda
authors.forename: Takuma
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Masataka
authors.initials: M
authors.lastname: Uetani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology; D001941:Breast Diseases / Q000473:pathology; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA