title: Diagnostic usefulness of water-to-fat ratio and choline concentration in malignant and benign breast lesions and normal breast parenchyma: an in vivo (1) H MRS study.
abstract: OBJECTIVE
  To compare total choline concentrations ([Cho]) and water-to-fat (W/F) ratios of subtypes of malignant lesions, benign lesions, and normal breast parenchyma and determine their usefulness in breast cancer diagnosis. Reference standard was histology.
  
  
  METHODS
  In this HIPPA compliant study, proton MRS was performed on 93 patients with suspicious lesions (>1 cm) who underwent MRI-guided interventional procedures, and on 27 prospectively accrued women enrolled for screening MRI. (W/F) and [Cho] values were calculated using MRS data.
  
  
  RESULTS
  Among 88 MRS-evaluable histologically-confirmed lesions, 40 invasive ductal carcinoma (IDC); 10 invasive lobular carcinoma (ILC); 4 ductal carcinoma in situ (DCIS); 3 invasive mammary carcinoma (IMC); 31 benign. No significant difference observed in (W/F) between benign lesions and normal breast tissue. The area under curve (AUC) of receiver operating characteristic (ROC) curves for discriminating the malignant group from the benign group were 0.97, 0.72, and 0.99 using [Cho], (W/F) and their combination as biomarkers, respectively. (W/F) performs significantly (P < 0.0001;AUC = 0.96) better than [Cho] (AUC = 0.52) in differentiating IDC and ILC lesions.
  
  
  CONCLUSIONS
  Although [Cho] and (W/F) are good biomarkers for differentiating malignancy, [Cho] is a better marker. Combining both can further improve diagnostic accuracy. IDC and ILC lesions have similar [Cho] levels but are discriminated using (W/F) values.
authors: Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. thakurs@mskcc.org
authors: Sunitha B
authors: SB
authors: Thakur
authors: Sandra B
authors: SB
authors: Brennan
authors: Nicole M
authors: NM
authors: Ishill
authors: Elizabeth A
authors: EA
authors: Morris
authors: Laura
authors: L
authors: Liberman
authors: D David
authors: DD
authors: Dershaw
authors: Lia
authors: L
authors: Bartella
authors: Jason A
authors: JA
authors: Koutcher
authors: Wei
authors: W
authors: Huang
mesh_terms: D000273:Adipose Tissue / Q000378:metabolism*; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism; D001834:Body Water / Q000378:metabolism*; D001940:Breast / Q000502:physiology*; D001941:Breast Diseases / Q000175:diagnosis* / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D002794:Choline / Q000378:metabolism*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D002794:Choline