title: Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer.
abstract: OBJECTIVE
  To evaluate whether visual assessment of T2-weighted imaging (T2WI) or an apparent diffusion coefficient (ADC) could predict lymphovascular invasion (LVI) status in cases with clinically node-negative invasive breast cancer.
  
  
  METHODS
  One hundred and thirty-six patients with 136 lesions underwent MRI. Visual assessment of T2WI, tumour-ADC, peritumoral maximum-ADC and the peritumour-tumour ADC ratio (the ratio between them) were compared with LVI status of surgical specimens.
  
  
  RESULTS
  No significant relationship was found between LVI and T2WI. Tumour-ADC was significantly lower in the LVI-positive (n = 77, 896 ± 148 × 10(-6) mm(2)/s) than the LVI-negative group (n = 59, 1002 ± 163 × 10(-6) mm(2)/s; p < 0.0001). Peritumoral maximum-ADC was significantly higher in the LVI-positive (1805 ± 355 × 10(-6) mm(2)/s) than the LVI-negative group (1625 ± 346 × 10(-6) mm(2)/s; p = 0.0003). Peritumour-tumour ADC ratio was significantly higher in the LVI-positive (2.05 ± 0.46) than the LVI-negative group (1.65 ± 0.40; p < 0.0001). Receiver operating characteristic curve analysis revealed that the area under the curve (AUC) of the peritumour-tumour ADC ratio was the highest (0.81). The most effective threshold for the peritumour-tumour ADC ratio was 1.84, and the sensitivity, specificity, positive predictive value and negative predictive value were 77% (59/77), 76% (45/59), 81% (59/73) and 71% (45/63), respectively.
  
  
  CONCLUSIONS
  We suggest that the peritumour-tumour ADC ratio can assist in predicting LVI status on preoperative imaging.
  
  
  CONCLUSIONS
  • Tumour ADC was significantly lower in LVI-positive than LVI-negative breast cancer. • Peritumoral maximum-ADC was significantly higher in LVI-positive than LVI-negative breast cancer. • Peritumour-tumour ADC ratio was significantly higher in LVI-positive breast cancer. • Diagnostic performance of the peritumour-tumour ADC ratio was highest for positive LVI. • Peritumour-tumour ADC ratio showed higher diagnostic ability in postmenopausal than premenopausal patients.
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan. naokomori7127@gmail.com.
authors.forename: Naoko
authors.initials: N
authors.lastname: Mori
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Mugikura
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Takasawa
authors.affiliation: Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Miyashita
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Shimauchi
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ota
authors.affiliation: Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Department of Pathology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Atsuko
authors.initials: A
authors.lastname: kasajima
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Takase
authors.affiliation: Department of Biomedical Engineering, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kodama
authors.affiliation: Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
authors.forename: Shoki
authors.initials: S
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008207:Lymphatic Metastasis; D042601:Lymphatic Vessels / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Beast Cancer; Diffusion-weighted MRI; Embolism; Lymphatic Vessels; Tumour