title: Differentiation of malignant and benign breast lesions: Added value of the qualitative analysis of breast lesions on diffusion-weighted imaging (DWI) using readout-segmented echo-planar imaging at 3.0 T.
abstract: OBJECTIVE
  To determine the added value of qualitative analysis as an adjunct to quantitative analysis for the discrimination of benign and malignant lesions in patients with breast cancer using diffusion-weighted imaging (DWI) with readout-segmented echo-planar imaging (rs-EPI).
  
  
  METHODS
  A total of 99 patients with 144 lesions were reviewed from our prospectively collected database. DWI data were obtained using rs-EPI acquired at 3.0 T. The diagnostic performances of DWI in the qualitative, quantitative, and combination analyses were compared with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Additionally, the effect of lesion size on the diagnostic performance of the DWI combination analysis was evaluated.
  
  
  RESULTS
  The strongest indicators of malignancy on DWI were a heterogeneous pattern (P = 0.005) and an apparent diffusion coefficient (ADC) value <1.0 × 10-3 mm2/sec (P = 0.002). The area under the curve (AUC) values for the qualitative analysis, quantitative analysis, and combination analysis on DWI were 0.732 (95% CI, 0.651-0.803), 0.780 (95% CI, 0.703-0.846), and 0.826 (95% CI, 0.754-0.885), respectively (P<0.0001). The AUC for the combination analysis on DWI was superior to that for DCE-MRI alone (0.651, P = 0.003) but inferior to that for DCE-MRI plus the ADC value (0.883, P = 0.03). For the DWI combination analysis, the sensitivity was significantly lower in the size ≤1 cm group than in the size >1 cm group (80% vs. 95.6%, P = 0.034).
  
  
  CONCLUSIONS
  Qualitative analysis of tumor morphology was diagnostically applicable on DWI using rs-EPI. This qualitative analysis adds value to quantitative analyses for lesion characterization in patients with breast cancer.
authors.affiliation: Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
authors.forename: Yeong Yi
authors.identifier: http://orcid.org/0000-0003-0905-8498
authors.initials: YY
authors.lastname: An
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
authors.forename: Sung Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Republic of Korea.
authors.forename: Bong Joo
authors.identifier: http://orcid.org/0000-0001-7506-5536
authors.initials: BJ
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D017352:Echo-Planar Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D008875:Middle Aged
chemical_list: D003287:Contrast Media