title: Supplemental use of optical diffusion breast imaging for differentiation between benign and malignant breast lesions.
abstract: OBJECTIVE
  The objective of our study was to prospectively evaluate the diagnostic accuracy of optical diffusion breast imaging in patients who underwent conventional ultrasound followed by surgery or biopsy.
  
  
  METHODS
  We performed optical diffusion breast imaging after conventional ultrasound of 193 patients (mean age, 47 years) with 217 lesions. All patients underwent ultrasound-guided core needle biopsy or surgery. One of six radiologists reviewed conventional ultrasound features, assessed a BI-RADS category, and reviewed optical diffusion imaging results for each lesion. Surgery and biopsy results were used as reference standards. We compared the diagnostic accuracy including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of conventional ultrasound alone and of conventional ultrasound followed by optical diffusion imaging. In addition, we prospectively investigated if total hemoglobin level or oxygen saturation level is the most reliable indicator in optical diffusion imaging.
  
  
  RESULTS
  Of the 217 breast lesions, 108 were malignant and 109 were benign. For differentiation of malignant from benign lesions, conventional ultrasound was associated with a sensitivity of 100%, specificity of 27.5%, PPV of 57.8%, NPV of 100%, and accuracy of 63.6%. The supplemental use of optical diffusion imaging after conventional ultrasound was associated with a sensitivity of 98.1%, specificity of 41.3%, PPV of 62.4%, NPV of 95.7%, and accuracy of 69.7%. The area under the receiver operating characteristic curve was 0.738 for total hemoglobin level and 0.502 for oxygen saturation level. The cutoff value was 0.195 mmol/L for total hemoglobin, with 68.4% sensitivity and 69.7% specificity.
  
  
  CONCLUSIONS
  Optical diffusion imaging might be a good supplemental tool to increase the diagnostic accuracy of conventional ultrasound in differentiating malignant from benign breast lesions.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Moon
authors.forename: Hak Hee
authors.initials: HH
authors.lastname: Kim
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Shin
authors.forename: Hyunji
authors.initials: H
authors.lastname: Kim
authors.forename: Myung-Su
authors.initials: MS
authors.lastname: Ko
authors.forename: Gyungyub
authors.initials: G
authors.lastname: Gong
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D041622:Tomography, Optical / Q000379:methods*; D018084:Ultrasonography, Interventional; D016217:Ultrasonography, Mammary