Journal Article
. 2016 Aug;85(9).
doi: 10.1016/j.ejrad.2016.06.019.

Quantitative apparent diffusion coefficient measurement obtained by 3.0Tesla MRI as a potential noninvasive marker of tumor aggressiveness in breast cancer

Manuela Durando 1 Lucas Gennaro 2 Gene Y Cho 3 Dilip D Giri 4 Merlin M Gnanasigamani 5 Sujata Patil 6 Elizabeth J Sutton 7 Joseph O Deasy 8 Elizabeth A Morris 9 Sunitha B Thakur 10 
  • PMID: 27501902
  •     32 References
  •     14 citations


Purpose: 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.

Materials And 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.

Conclusion: 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.

Keywords: Breast cancer; DW-MRI at 3.0T; Lymph nodes; Lymphovascular invasion; Prognostic factors.

Diffusion-weighted imaging of breast cancer: correlation of the apparent diffusion coefficient value with prognostic factors.
Sung Hun Kim, Eun Suk Cha, +5 authors, Young Jin Suh.
J Magn Reson Imaging, 2009 Aug 28; 30(3). PMID: 19711411
Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer.
Naoko Mori, Shunji Mugikura, +8 authors, Shoki Takahashi.
Eur Radiol, 2015 May 31; 26(2). PMID: 26024846
Apparent diffusion coefficient values for discriminating benign and malignant breast MRI lesions: effects of lesion type and size.
Savannah C Partridge, Christiane D Mullins, +4 authors, Constance D Lehman.
AJR Am J Roentgenol, 2010 May 22; 194(6). PMID: 20489111
Prognostic value of lymphangiogenesis and lymphovascular invasion in invasive breast cancer.
Sebastian F Schoppmann, Guenther Bayer, +10 authors, Austrian Breast and Colorectal Cancer Study Group.
Ann Surg, 2004 Jul 27; 240(2). PMID: 15273556    Free PMC article.
Quantitative apparent diffusion coefficient as a noninvasive imaging biomarker for the differentiation of invasive breast cancer and ductal carcinoma in situ.
Hubert Bickel, Katja Pinker-Domenig, +5 authors, Pascal Baltzer.
Invest Radiol, 2014 Oct 22; 50(2). PMID: 25333308
Diffusion-weighted imaging improves the diagnostic accuracy of conventional 3.0-T breast MR imaging.
Riham H Ei Khouli, Michael A Jacobs, +4 authors, David A Bluemke.
Radiology, 2010 Jun 25; 256(1). PMID: 20574085    Free PMC article.
Highly Cited.
Diffusion-weighted imaging in breast cancer: relationship between apparent diffusion coefficient and tumour aggressiveness.
M Costantini, P Belli, +5 authors, L Bonomo.
Clin Radiol, 2010 Nov 13; 65(12). PMID: 21070905
Apparent Diffusion Coefficient in Invasive Ductal Breast Carcinoma: Correlation with Detailed Histologic Features and the Enhancement Ratio on Dynamic Contrast-Enhanced MR Images.
Roka Namoto Matsubayashi, Teruhiko Fujii, +2 authors, Seiya Momosaki.
J Oncol, 2010 Sep 28; 2010. PMID: 20871661    Free PMC article.
Prognostic value of lymphovascular invasion in women with lymph node negative invasive breast carcinoma.
A H S Lee, S E Pinder, +4 authors, R W Blamey.
Eur J Cancer, 2005 Dec 27; 42(3). PMID: 16377180
Diffusion-weighted imaging in cancer: physical foundations and applications of restriction spectrum imaging.
Nathan S White, Carrie McDonald, +25 authors, Anders M Dale.
Cancer Res, 2014 Sep 04; 74(17). PMID: 25183788    Free PMC article.
Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer.
Nehmat Houssami, Stefano Ciatto, +4 authors, Les Irwig.
J Clin Oncol, 2008 May 14; 26(19). PMID: 18474876
Highly Cited. Systematic Review.
Triple-negative invasive breast cancer on dynamic contrast-enhanced and diffusion-weighted MR imaging: comparison with other breast cancer subtypes.
Ji Hyun Youk, Eun Ju Son, +2 authors, Eun-Kyung Kim.
Eur Radiol, 2012 Apr 25; 22(8). PMID: 22527371
Correlations between apparent diffusion coefficient values of invasive ductal carcinoma and pathologic factors on diffusion-weighted MRI at 3.0 Tesla.
Sung Hee Park, Hye-Young Choi, Soo Yeon Hahn.
J Magn Reson Imaging, 2013 Dec 20; 41(1). PMID: 24353241
Correlation of the apparent diffusion coefficiency values on diffusion-weighted imaging with prognostic factors for breast cancer.
S Y Choi, Y-W Chang, +3 authors, D Y Seo.
Br J Radiol, 2011 Dec 01; 85(1016). PMID: 22128125    Free PMC article.
New molecular classifications of breast cancer.
Mary Cianfrocca, William Gradishar.
CA Cancer J Clin, 2009 Sep 05; 59(5). PMID: 19729680
Accuracy of MRI in prediction of pathologic complete remission in breast cancer after preoperative therapy: a meta-analysis.
Ying Yuan, Xiao-Song Chen, Shi-Yuan Liu, Kun-Wei Shen.
AJR Am J Roentgenol, 2010 Jun 23; 195(1). PMID: 20566826
Natural history of node-negative breast cancer: are conventional prognostic factors predictors of time to relapse?
Michel Héry, Thierry Delozier, +7 authors, Eric Teissier.
Breast, 2004 Feb 18; 11(5). PMID: 14965709
Breast cancer prognostic classification in the molecular era: the role of histological grade.
Emad A Rakha, Jorge S Reis-Filho, +15 authors, Ian O Ellis.
Breast Cancer Res, 2010 Sep 02; 12(4). PMID: 20804570    Free PMC article.
Highly Cited. Review.
Correlation of the apparent diffusion coefficient value and dynamic magnetic resonance imaging findings with prognostic factors in invasive ductal carcinoma.
Su Kyung Jeh, Sung Hun Kim, +4 authors, Byung Joo Song.
J Magn Reson Imaging, 2010 Dec 25; 33(1). PMID: 21182127
Diffusion-weighted imaging: determination of the best pair of b-values to discriminate breast lesions.
L Nogueira, S Brandão, +4 authors, I Ramos.
Br J Radiol, 2014 May 17; 87(1039). PMID: 24834475    Free PMC article.
Diagnostic and prognostic value of pretreatment SUV in 18F-FDG/PET in breast cancer: comparison with apparent diffusion coefficient from diffusion-weighted MR imaging.
Shingo Baba, Takuro Isoda, +4 authors, Hiroshi Honda.
J Nucl Med, 2014 Mar 26; 55(5). PMID: 24665089
Breast cancer heterogeneity: mechanisms, proofs, and implications.
Yi-Hsuan Hsiao, Ming-Chih Chou, +2 authors, Yan-Gao Man.
J Cancer, 2010 Sep 16; 1. PMID: 20842218    Free PMC article.
Invasive ductal carcinoma: correlation of apparent diffusion coefficient value with pathological prognostic factors.
Ahmed Abdel Khalek Abdel Razek, Gada Gaballa, Adel Denewer, Nadia Nada.
NMR Biomed, 2010 Mar 17; 23(6). PMID: 20232453
Invasive lobular carcinoma of the breast: morphology, biomarkers and 'omics.
Amy E McCart Reed, Jamie R Kutasovic, Sunil R Lakhani, Peter T Simpson.
Breast Cancer Res, 2015 Apr 08; 17. PMID: 25849106    Free PMC article.
Highly Cited. Review.
Tumor characteristics of breast cancer in predicting axillary lymph node metastasis.
Hsin-Shun Tseng, Li-Sheng Chen, +3 authors, Dar-Ren Chen.
Med Sci Monit, 2014 Jul 08; 20. PMID: 24998473    Free PMC article.
Correlations between diffusion-weighted imaging and breast cancer biomarkers.
Laura Martincich, Veronica Deantoni, +9 authors, Filippo Montemurro.
Eur Radiol, 2012 Mar 14; 22(7). PMID: 22411304
The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer.
Young Ju Song, Sun Hyoung Shin, +3 authors, Young Jong Jegal.
J Breast Cancer, 2011 Oct 28; 14(3). PMID: 22031801    Free PMC article.
Intravoxel incoherent motion diffusion-weighted MRI at 3.0 T differentiates malignant breast lesions from benign lesions and breast parenchyma.
Louisa Bokacheva, Jennifer B Kaplan, +6 authors, Sunitha B Thakur.
J Magn Reson Imaging, 2013 Nov 26; 40(4). PMID: 24273096    Free PMC article.
Correlations between apparent diffusion coefficient values and prognostic factors of breast cancer.
Takeshi Kamitani, Yoshio Matsuo, +10 authors, Hiroshi Honda.
Magn Reson Med Sci, 2013 Jul 17; 12(3). PMID: 23857151
A new look at node-negative breast cancer.
Nadia Harbeck, Christoph Thomssen.
Oncologist, 2011 Feb 10; 16 Suppl 1. PMID: 21278441
Heterogeneity in breast cancer.
Kornelia Polyak.
J Clin Invest, 2011 Oct 04; 121(10). PMID: 21965334    Free PMC article.
Highly Cited.
Magnetic resonance imaging features in triple-negative breast cancer: comparison with luminal and HER2-overexpressing tumors.
Melania Costantini, Paolo Belli, +7 authors, Lorenzo Bonomo.
Clin Breast Cancer, 2012 Oct 09; 12(5). PMID: 23040001
Is the necrosis/wall ADC ratio useful for the differentiation of benign and malignant breast lesions?
Irmak Durur-Subasi, Afak Durur-Karakaya, +3 authors, Fatih Alper.
Br J Radiol, 2017 Mar 25; 90(1073). PMID: 28339285    Free PMC article.
Apparent diffusion coefficient in estrogen receptor-positive and lymph node-negative invasive breast cancers at 3.0T DW-MRI: A potential predictor for an oncotype Dx test recurrence score.
Sunitha B Thakur, Manuela Durando, +5 authors, Elizabeth A Morris.
J Magn Reson Imaging, 2017 Jun 24; 47(2). PMID: 28640531    Free PMC article.
Clinical role of breast MRI now and going forward.
D Leithner, G J Wengert, +4 authors, K Pinker.
Clin Radiol, 2017 Dec 13; 73(8). PMID: 29229179    Free PMC article.
Is there any relationship between adc values of diffusion-weighted imaging and the histopathological prognostic factors of invasive ductal carcinoma?
Hale Aydin, Bahar Guner, +4 authors, Mehmet Ali Gulcelik.
Br J Radiol, 2018 Jan 05; 91(1084). PMID: 29299933    Free PMC article.
Correlation between minimum apparent diffusion coefficient values and the histological grade of breast invasive ductal carcinoma.
Suhong Zhao, Weihua Guo, +4 authors, Guangrui Shao.
Oncol Lett, 2018 Jun 01; 15(5). PMID: 29849809    Free PMC article.
Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping as a quantitative imaging biomarker for prediction of immunohistochemical receptor status, proliferation rate, and molecular subtypes of breast cancer.
Joao V Horvat, Blanca Bernard-Davila, +11 authors, Katja Pinker.
J Magn Reson Imaging, 2019 Feb 28; 50(3). PMID: 30811717    Free PMC article.
Added value of histogram analysis of apparent diffusion coefficient maps for differentiating triple-negative breast cancer from other subtypes of breast cancer on standard MRI.
Hong-Li Liu, Min Zong, +5 authors, Yan-Ni Jiang.
Cancer Manag Res, 2019 Oct 01; 11. PMID: 31564982    Free PMC article.
Can apparent diffusion coefficient (ADC) distinguish breast cancer from benign breast findings? A meta-analysis based on 13 847 lesions.
Alexey Surov, Hans Jonas Meyer, Andreas Wienke.
BMC Cancer, 2019 Oct 17; 19(1). PMID: 31615463    Free PMC article.
Diffusion-Weighted Magnetic Resonance Imaging of Patients with Breast Cancer Following Neoadjuvant Chemotherapy Provides Early Prediction of Pathological Response - A Prospective Study.
Nara P Pereira, Carla Curi, +4 authors, Almir G V Bitencourt.
Sci Rep, 2019 Nov 11; 9(1). PMID: 31705004    Free PMC article.
Histogram Analysis and Visual Heterogeneity of Diffusion-Weighted Imaging with Apparent Diffusion Coefficient Mapping in the Prediction of Molecular Subtypes of Invasive Breast Cancers.
Joao V Horvat, Aditi Iyer, +9 authors, Sunitha B Thakur.
Contrast Media Mol Imaging, 2019 Dec 11; 2019. PMID: 31819738    Free PMC article.
Diffusion weighted magnetic resonance imaging (DW-MRI) as a non-invasive, tissue cellularity marker to monitor cancer treatment response.
Frederikke Petrine Fliedner, Trine Bjørnbo Engel, +2 authors, Andreas Kjaer.
BMC Cancer, 2020 Feb 23; 20(1). PMID: 32075610    Free PMC article.
Sequential [18F]FDG-[18F]FMISO PET and Multiparametric MRI at 3T for Insights into Breast Cancer Heterogeneity and Correlation with Patient Outcomes: First Clinical Experience.
Piotr Andrzejewski, Georg Wengert, +9 authors, Katja Pinker.
Contrast Media Mol Imaging, 2019 Feb 08; 2019. PMID: 30728757    Free PMC article.
Diffusion-weighted imaging of the breast: current status as an imaging biomarker and future role.
Julia Camps-Herrero.
BJR Open, 2019 Mar 08; 1(1). PMID: 33178933    Free PMC article.
Predictive Models in Differentiating Vertebral Lesions Using Multiparametric MRI.
R Rathore, A Parihar, +4 authors, A Chandra.
AJNR Am J Neuroradiol, 2017 Oct 14; 38(12). PMID: 29025721    Free PMC article.