title: Early-stage invasive ductal carcinoma: Association of tumor apparent diffusion coefficient values with axillary lymph node metastasis.
abstract: OBJECTIVE
  To evaluate any association between tumor apparent diffusion coefficient (ADC) values and axillary lymph node metastasis (ALNM) in early-stage invasive ductal carcinoma.
  
  
  METHODS
  Records of 270 invasive ductal carcinoma patients with stages T1 and T2 disease who underwent breast magnetic resonance imaging, including diffusion-weighted imaging with b values of 0 and 1000s/mm(2) were reviewed retrospectively. The tumor ADC values were analyzed for their utility in predicting ALNM using multivariate regression analysis and receiver operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  Of the 270 patients, 58 (21.5%) experienced ALNM. The mean tumor ADC values were significantly lower in patients with ALNM than in those without metastasis (0.880 × 10(-3) vs. 0.999 × 10(-3)mm(2)/s, P<0.001). A ROC curve demonstrated a tumor ADC value of 0.991 × 10(-3)mm(2)/s to be the optimal cut-off for predicting ALNM. In a multivariate analysis, lower tumor ADC (≤ 0.991 × 10(-3)mm(2)/s; adjusted odds ratio (OR)=5.861, P<0.001), large tumor size (>2 cm; adjusted OR=3.156, P=0.002) and the presence of lymphovascular invasion (adjusted OR=4.125, P<0.001) were independent variables associated with ALNM. When tumor ADC value was added to known risk factors (i.e., tumor size and lymphovascular invasion), a significant improvement in the accuracy of risk prediction for axillary node metastasis was shown (c-statistic=0.758 vs. 0.816, P=0.026).
  
  
  CONCLUSIONS
  In early-stage invasive ductal carcinoma, lower tumor ADC values are associated with the presence of ALNM.
authors: Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea. Electronic address: youdosa@naver.com.
authors: Jin You
authors: JY
authors: Kim
authors: Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea.
authors: Hie Bum
authors: HB
authors: Seo
authors: Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea.
authors: Shinyoung
authors: S
authors: Park
authors: Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea.
authors: Jin Il
authors: JI
authors: Moon
authors: Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea.
authors: Ji Won
authors: JW
authors: Lee
authors: Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Republic of Korea.
authors: Nam Kyung
authors: NK
authors: Lee
authors: Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea.
authors: Seok Won
authors: SW
authors: Lee
authors: Department of Surgery, Pusan National University Hospital, Busan, Republic of Korea.
authors: Young Tae
authors: YT
authors: Bae
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla / Q000473:pathology*; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology*; D044584:Carcinoma, Ductal / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012189:Retrospective Studies
keywords: Diffusion-weighted MRI; Invasive ductal carcinoma; Lymph nodes; Metastasis