title: Prediction of low-risk breast cancer using perfusion parameters and apparent diffusion coefficient.
abstract: OBJECTIVE
  To assess whether perfusion and diffusion parameters were different between low-risk tumors and non-low-risk tumors.
  
  
  METHODS
  We prospectively enrolled 87 patients with 91 tumors patients (mean, 49.6 years; range, 29-74 years) who underwent definitive surgery. We defined estrogen receptor (ER)-positive tumors with low histologic grade (HG), low Ki67 (<14%), and negative lymph node metastasis as a low-risk breast cancer. We obtained quantitative and semiquantitative perfusion parameters and apparent diffusion coefficient (ADC) for all tumors. We compared perfusion parameters and ADCs between low-risk tumors (n=33; 36%) and the others (n=58; 64%) using Fisher's exact test, Chi-square test, and student t-test. We developed empirical model to predict low-risk tumor using logistic regression analysis and receiver operating characteristics (ROC) analysis.
  
  
  RESULTS
  On univariate analysis, wash-in and the initial area under the curve on qualitative analysis (iAUCqualitative) were significantly different according to HG, ER, HER-2, Ki67 and lymphovascular invasion (P<.05 for all variables). ADCdiff was significantly different according to HG, HER-2, and Ki67 status (P=.010, .007, and .013). On multivariate analysis, Ktrans, iAUCqualitative, and ADCdiff were the significant variables for the prediction of low-risk tumors, and the area under the ROC curve (AUC) of combined parameters was 0.78, which was higher than those of the individual parameter. ADCdiff was positively correlated with wash-in (r=0.263) and iAUCqualitative (r=0.245), respectively.
  
  
  CONCLUSIONS
  The prediction model using Ktrans, wash in, iAUCqualitative, and ADCdiff on DCE-MRI and DWI could be helpful for identifying of low-risk breast cancer and may be used as an imaging biomarker to guide the treatment plan.
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea. Electronic address: docshin@amc.seoul.kr.
authors.forename: Hee Jung
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Hak Hee
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Radiology and Research Institute of Radiology, Medical Imaging Laboratory, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Ki Chang
authors.initials: KC
authors.lastname: Shin
authors.affiliation: Department of Radiology and Research Institute of Radiology, Medical Imaging Laboratory, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Yoo Sub
authors.initials: YS
authors.lastname: Sung
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Joo Hee
authors.initials: JH
authors.lastname: Cha
authors.affiliation: Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Son
authors.affiliation: Department of Breast and Endocrine Surgery, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Sei Hyun
authors.initials: SH
authors.lastname: Ahn
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003198:Computer Simulation; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012680:Sensitivity and Specificity
keywords: Breast neoplasm; DCE-MRI; Diffusion-weighted imaging; Low-risk breast cancer