title: Quantitative apparent diffusion coefficient measurement obtained by 3.0Tesla MRI as a potential noninvasive marker of tumor aggressiveness in breast cancer.
abstract: OBJECTIVE
  To assess the association between apparent diffusion coefficient (ADC), and histological prognostic parameters in malignant breast lesions. The ability of ADC to identify lesions with the presence of Lymphovascular invasion (LVI) in breast carcinoma was also examined.
  
  
  METHODS
  This HIPAA-compliant retrospective study consisted of 212 consecutive patients with known cancers who underwent 3.0T MRI between January 2011 and 2013. In this study, a total of 126 malignant lesions in 114 women, who had undergone DWI (b-values of 0 and 1000s/mm(2)) in addition to diagnostic MRI, were included. Patients with less than 0.8cm lesions, or those who underwent neoadjuvant chemotherapy or suboptimal DW images were excluded. Classical prognostic factors [lesion size, histopathological type and grade, lymph node (LN) status and lymphovascular invasion (LVI)], molecular prognostic markers [estrogen receptor (ER), progesterone receptor (PR) and human epidermal grow factor receptor 2 (HER2)] were reviewed and recorded. A region of interest (ROI) was drawn within the lesions to measure ADC values. Statistical analyses were performed by the Wilcoxon rank sum test (statistical significance at P<0.05). Adjusted p values from multiple comparison analysis were also calculated.
  
  
  RESULTS
  This study demonstrates an inverse correlation between ADC and LVI in malignant lesions and the ability of ADC to identify aggressiveness in lesions with positive LVI. Tumor size, grade, ER, PR, HER2 and lymph node status did not impact tumor ADC value. However, tumors with LVI showed significantly lower ADC values when compared to tumors without LVI, regardless of the enhancement type, histological grade, histological type, and LN status.
  
  
  CONCLUSIONS
  Our study shows that ADC could be a potential clinical adjunct in the evaluation of prognostic factors related to malignant lesion aggressiveness such as LVI.
authors: Department of Diagnostic Imaging and Radiotherapy, A. O. U. Città della Salute e della Scienza of Turin, 10126, Italy. Electronic address: mdurando@inwind.it.
authors: Manuela
authors: M
authors: Durando
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA. Electronic address: gennarol@mskcc.org.
authors: Lucas
authors: L
authors: Gennaro
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA. Electronic address: chog@mskcc.org.
authors: Gene Y
authors: GY
authors: Cho
authors: Department of Pathology, Memorial Sloan-Kettering Cancer Center, 300 East 66th street, NY 10065, USA. Electronic address: girid@mskcc.org.
authors: Dilip D
authors: DD
authors: Giri
authors: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA. Electronic address: merlinmargaret@gmail.com.
authors: Merlin M
authors: MM
authors: Gnanasigamani
authors: Department of Biostatistics, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, NY 10065, USA. Electronic address: patils@mskcc.org.
authors: Sujata
authors: S
authors: Patil
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA. Electronic address: suttone@mskcc.org.
authors: Elizabeth J
authors: EJ
authors: Sutton
authors: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA. Electronic address: deasyj@mskcc.org.
authors: Joseph O
authors: JO
authors: Deasy
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA. Electronic address: morrise@mskcc.org.
authors: Elizabeth A
authors: EA
authors: Morris
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 300 East, 66th street, NY 10065, USA; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY 10065, USA. Electronic address: thakurs@mskcc.org.
authors: Sunitha B
authors: SB
authors: Thakur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D011379:Prognosis; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
keywords: Breast cancer; DW-MRI at 3.0T; Lymph nodes; Lymphovascular invasion; Prognostic factors