title: Diffusion-weighted imaging (b value = 1500 s/mm(2)) is useful to decrease false-positive breast cancer cases due to fibrocystic changes.
abstract: BACKGROUND
  We aimed to evaluate the application of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging (DWI) (b value = 1500 s/mm(2)) in the breast imaging reporting and data system (BI-RADS).
  
  
  METHODS
  For 104 cases of breast lesions with definitive histology diagnosis (45 benign cases, 59 malignant cases) in which breast magnetic resonance imaging was performed, ADC values were compared between benign and malignant cases, between ductal carcinoma in situ (DCIS) and fibrocystic changes, and between DCIS and ductal hyperplasia (one type of fibrocystic change). Diagnostic accuracy was compared for a total of 101 images and for 34 images including only nine DCIS and 25 fibrocystic changes between BI-RADS alone (with categories 4a, 4b, and 5 defined as malignancies) and BI-RADS plus ADC.
  
  
  RESULTS
  There were significant differences in mean ADC values between malignant and benign cases (p < 0.0001) and between DCIS and fibrocystic changes (p < 0.002), but not between DCIS and ductal hyperplasia. Positive predictive values were significantly greater for BI-RADS plus ADC than for BI-RADS alone in all cases (70.5% for BI-RADS alone, 81.3% for BI-RADS plus ADC) and in cases of DCIS versus fibrocystic changes (40.9% for BI-RADS alone, 64.3% for BI-RADS plus ADC), resulting in a significant improvement in diagnostic accuracy with the addition of ADC.
  
  
  CONCLUSIONS
  Adding ADC values calculated from DWI (b value = 1500 s/mm(2)) to BI-RADS is a useful way to improve differential diagnostic accuracy for malignant tumors and benign lesions, especially for DCIS versus fibrocystic changes, except in cases of ductal hyperplasia.
authors.affiliation: Diagnostic Radiology Department, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan. mochih1@aih-net.com
authors.forename: Miho
authors.initials: M
authors.lastname: Ochi
authors.forename: Toshiro
authors.initials: T
authors.lastname: Kuroiwa
authors.forename: Shunya
authors.initials: S
authors.lastname: Sunami
authors.forename: Junji
authors.initials: J
authors.lastname: Murakami
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Nagaie
authors.forename: Masafumi
authors.initials: M
authors.lastname: Oya
authors.forename: Hidetake
authors.initials: H
authors.lastname: Yabuuchi
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Hatakenaka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D055815:Young Adult