Journal Article
. 2018 Jan; 91(1084):20170705.
doi: 10.1259/bjr.20170705.

Is there any relationship between adc values of diffusion-weighted imaging and the histopathological prognostic factors of invasive ductal carcinoma?

Hale Aydin 1 Bahar Guner 1 Isil Esen Bostanci 1 Zarife Melda Bulut 2 Bilgin Kadri Aribas 1 Lutfi Dogan 3 Mehmet Ali Gulcelik 3 
  • PMID: 29299933
  •     50 References
  •     6 citations


Objective: MRI is being used increasingly as a modality that can provide important information about breast cancer. Diffusion-weighted imaging (DWI) is an imaging technique from which apparent diffusion coefficient (ADC) values can be calculated in addition to obtaining important structural information which cannot be obtained from other imaging studies. We did not find any significant relationships between ADC values and prognostic factors, but did provide some explanations for conflicting results in the literature.

Methods: The ADC results of 61 females with invasive ductal carcinomas were evaluated. DWI was performed and ADC values were calculated from the area in which restriction of diffusion was the highest in ADC mapping. B value was 500 and region of interest (ROI) was designated between 49 and 100 mm2. Calculations were performed automatically by the device. Tissue samples were obtained for prognostic factor evaluation. The relationships between ADC and prognostic factors were investigated. Comparisons between groups were made with one-way ANOVA and Kruskal Wallis test. Pairwise comparisons were made with Dunn's test. Analyses of categorical variables were made with Chi-square test.

Results: We found a weak negative correlation between ADC and Ki-67 values (r = -0.279; p = 0.029). When we compared ADC values in regard to tumour type, we found no significant differences for tumour grade, Ki-67 positivity, estrogen receptor positivity, progesterone receptor positivity, C-erb B2, lymphovascular invasion and ductal carcinoma in situ or lobular carcinoma in situ component. On a side note, we found that mean ADC values decreased as tumour grade increased; however, this was not statistically significant.

Conclusion: The literature contains studies that report conflicting results which may be caused by differences in B values, ROI area and magnetic field strength. Multicentre studies and systematic reviews of these findings may produce crucial data for the use of DWI in breast cancer. Advances in knowledge: To determine if any significant relationship exists between DWI findings and prognostic factors of breast cancer.

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
Diagnostic performance of ADC for Non-mass-like breast lesions on MR imaging.
Tsugumi Imamura, Ichiro Isomoto, +7 authors, Masataka Uetani.
Magn Reson Med Sci, 2010 Dec 29; 9(4). PMID: 21187691
Molecular Breast Imaging and the 2016 Update to the ACR Appropriateness Criteria for Breast Cancer Screening.
Matthew F Covington, Deborah J Rhodes, Victor J Pizzitola.
J Am Coll Radiol, 2016 Dec 06; 13(12 Pt A). PMID: 27916107
Quantitative diffusion-weighted imaging as an adjunct to conventional breast MRI for improved positive predictive value.
Savannah C Partridge, Wendy B DeMartini, +3 authors, Constance D Lehman.
AJR Am J Roentgenol, 2009 Nov 26; 193(6). PMID: 19933670
Can Diffusion-Weighted Imaging and Related Apparent Diffusion Coefficient be a Prognostic Value in Women With Breast Cancer?
Paola Rabasco, Rocchina Caivano, +10 authors, Aldo Cammarota.
Cancer Invest, 2017 Jan 21; 35(2). PMID: 28107084
The impact of FDG-PET/CT on the management of breast cancer patients with elevated tumor markers and negative or equivocal conventional imaging modalities.
Vasiliki Filippi, Joulia Malamitsi, +4 authors, John Andreou.
Nucl Med Commun, 2010 Dec 04; 32(2). PMID: 21127445
Meta-analysis of MR imaging in the diagnosis of breast lesions.
Nicky H G M Peters, Inne H M Borel Rinkes, +3 authors, Petra H M Peeters.
Radiology, 2007 Nov 21; 246(1). PMID: 18024435
Highly Cited.
Current status of the prognostic molecular biomarkers in breast cancer: A systematic review.
Goro Kutomi, Toru Mizuguchi, +4 authors, Koichi Hirata.
Oncol Lett, 2017 Apr 30; 13(3). PMID: 28454281    Free PMC article.
A critical review why assessment of steroid hormone receptors in breast cancer should be quantitative.
O Brouckaert, R Paridaens, +3 authors, P Neven.
Ann Oncol, 2012 Aug 01; 24(1). PMID: 22847811
Screening with magnetic resonance imaging, mammography and ultrasound in women at average and intermediate risk of breast cancer.
Tomasz Huzarski, Barbara Górecka-Szyld, +17 authors, Polish Hereditary Breast Cancer Study Group.
Hered Cancer Clin Pract, 2017 Mar 08; 15. PMID: 28265306    Free PMC article.
Emerging modalities in breast cancer imaging.
Shadi Aminololama-Shakeri, Vijay P Khatri.
Surg Oncol Clin N Am, 2014 Sep 24; 23(4). PMID: 25246048
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 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 as an MR imaging biomarker of low-risk ductal carcinoma in situ: a pilot study.
Mami Iima, Denis Le Bihan, +7 authors, Kaori Togashi.
Radiology, 2011 Jun 03; 260(2). PMID: 21633054
Erratum to: 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 Jul 04; 26(2). PMID: 26139317
Non-mass-like enhancement on contrast-enhanced breast MR imaging: lesion characterization using combination of dynamic contrast-enhanced and diffusion-weighted MR images.
Hidetake Yabuuchi, Yoshio Matsuo, +9 authors, Hiroshi Honda.
Eur J Radiol, 2009 Oct 03; 75(1). PMID: 19796900
Histogram analysis of apparent diffusion coefficient at 3.0t: Correlation with prognostic factors and subtypes of invasive ductal carcinoma.
Eun Jeong Kim, Sung Hun Kim, +8 authors, Robert Grimm.
J Magn Reson Imaging, 2015 Apr 29; 42(6). PMID: 25919239
The role of new imaging modalities in staging and follow-up of breast cancer.
S A Feig.
Semin Oncol, 1986 Dec 01; 13(4). PMID: 3541212
Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up.
C W Elston, I O Ellis.
Histopathology, 1991 Nov 01; 19(5). PMID: 1757079
Highly Cited.
Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer.
Wendie A Berg, Lorena Gutierrez, +4 authors, Olga B Ioffe.
Radiology, 2004 Oct 16; 233(3). PMID: 15486214
Highly Cited.
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.
ADC mapping of benign and malignant breast tumors.
Reiko Woodhams, Keiji Matsunaga, +6 authors, Kazushige Hayakawa.
Magn Reson Med Sci, 2005 Aug 30; 4(1). PMID: 16127252
The Italian multi-centre project on evaluation of MRI and other imaging modalities in early detection of breast cancer in subjects at high genetic risk.
F Podo, F Sardanelli, +58 authors, A Del Maschio.
J Exp Clin Cancer Res, 2003 Feb 15; 21(3 Suppl). PMID: 12585665
Apparent diffusion coefficient on 3.0 Tesla magnetic resonance imaging and prognostic factors in breast cancer.
C De Felice, V Cipolla, +4 authors, M L Meggiorini.
Eur J Gynaecol Oncol, 2014 Aug 15; 35(4). PMID: 25118482
Quantitative apparent diffusion coefficient measurement obtained by 3.0Tesla MRI as a potential noninvasive marker of tumor aggressiveness in breast cancer.
Manuela Durando, Lucas Gennaro, +7 authors, Sunitha B Thakur.
Eur J Radiol, 2016 Aug 10; 85(9). PMID: 27501902    Free PMC article.
Diffusion-weighted breast MRI: Clinical applications and emerging techniques.
Savannah C Partridge, Noam Nissan, +2 authors, Eric E Sigmund.
J Magn Reson Imaging, 2016 Oct 01; 45(2). PMID: 27690173    Free PMC article.
Highly Cited. Review.
Applications of diffusion-weighted and diffusion tensor MRI to white matter diseases - a review.
Mark A Horsfield, Derek K Jones.
NMR Biomed, 2002 Dec 19; 15(7-8). PMID: 12489103
Highly Cited. Review.
Association of DW/DCE-MRI features with prognostic factors in breast cancer.
Guoliang Shao, Linyin Fan, +2 authors, Tieming Xie.
Int J Biol Markers, 2016 Oct 30; 32(1). PMID: 27646773
Application of Abbreviated Protocol of Magnetic Resonance Imaging for Breast Cancer Screening in Dense Breast Tissue.
Shuang-Qing Chen, Min Huang, +2 authors, Chuan-Xiao Xu.
Acad Radiol, 2016 Dec 06; 24(3). PMID: 27916594
Diagnostic Value of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of Metastatic Axillary Lymph Nodes in a Sample of Iranian Women with Breast Cancer
Fereshteh Hasanzadeh, Fariborz Faeghi, Abdollah Valizadeh, Leyla Bayani.
Asian Pac J Cancer Prev, 2017 Jun 15; 18(5). PMID: 28610412    Free PMC article.
Pathological prognostic factors in breast cancer. II. Histological type. Relationship with survival in a large study with long-term follow-up.
I O Ellis, M Galea, +3 authors, C W Elston.
Histopathology, 1992 Jun 01; 20(6). PMID: 1607149
Highly Cited.
Factors predictive of response to hormone therapy in breast cancer.
Francesca Rastelli, Sergio Crispino.
Tumori, 2008 Aug 19; 94(3). PMID: 18705406
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
Magnetic resonance imaging in patients diagnosed with ductal carcinoma-in-situ: value in the diagnosis of residual disease, occult invasion, and multicentricity.
E Shelley Hwang, Karen Kinkel, +3 authors, Nola M Hylton.
Ann Surg Oncol, 2003 May 08; 10(4). PMID: 12734086
Diffusion Weighted MR Imaging of Breast and Correlation of Prognostic Factors in Breast Cancer.
İnci Kızıldağ Yırgın, Gözde Arslan, +5 authors, Eyüp Kaya.
Balkan Med J, 2016 Jun 17; 33(3). PMID: 27308074    Free PMC article.
Magnetic resonance (MR) differential diagnosis of breast tumors using apparent diffusion coefficient (ADC) on 1.5-T.
Yoshito Tsushima, Ayako Takahashi-Taketomi, Keigo Endo.
J Magn Reson Imaging, 2009 Jul 25; 30(2). PMID: 19629992
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
Breast imaging of the pregnant and lactating patient: imaging modalities and pregnancy-associated breast cancer.
Reena Vashi, Regina Hooley, +2 authors, Liane Philpotts.
AJR Am J Roentgenol, 2013 Jan 25; 200(2). PMID: 23345353
Additional Value of Diffusion-Weighted Imaging to Evaluate Prognostic Factors of Breast Cancer: Correlation with the Apparent Diffusion Coefficient.
Eun Kyung Park, Kyu Ran Cho, +3 authors, Jeoung Won Bae.
Iran J Radiol, 2016 Apr 30; 13(1). PMID: 27127582    Free PMC article.
ACR Appropriateness Criteria Breast Cancer Screening.
Martha B Mainiero, Ana Lourenco, +16 authors, Bruce G Haffty.
J Am Coll Radiol, 2016 Nov 07; 13(11S). PMID: 27814813
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
Magnetic resonance imaging in breast cancer: A literature review and future perspectives.
Gisela Lg Menezes, Floor M Knuttel, +2 authors, Maurice Aaj van den Bosch.
World J Clin Oncol, 2014 May 16; 5(2). PMID: 24829852    Free PMC article.
Diffusion magnetic resonance imaging in breast cancer characterisation: correlations between the apparent diffusion coefficient and major prognostic factors.
Paolo Belli, Melania Costantini, +4 authors, Lorenzo Bonomo.
Radiol Med, 2014 Aug 07; 120(3). PMID: 25096888
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
Dynamic contrast-enhanced and diffusion-weighted MRI of estrogen receptor-positive invasive breast cancers: Associations between quantitative MR parameters and Ki-67 proliferation status.
Jong Ki Shin, Jin You Kim.
J Magn Reson Imaging, 2016 Jun 18; 45(1). PMID: 27313102
In vivo assessment of ductal carcinoma in situ grade: a model incorporating dynamic contrast-enhanced and diffusion-weighted breast MR imaging parameters.
Habib Rahbar, Savannah C Partridge, +4 authors, Constance D Lehman.
Radiology, 2012 Apr 21; 263(2). PMID: 22517955    Free PMC article.
Breast cancer imaging--what are the optimal modalities?
M Douek, T Davidson, I Taylor.
Eur J Surg Oncol, 1998 Dec 31; 24(6). PMID: 9870737
Advanced imaging modalities in early stage breast cancer: preoperative use in the United States Medicare population.
Margaret L Crivello, Karen Ruth, +5 authors, Richard J Bleicher.
Ann Surg Oncol, 2012 Aug 11; 20(1). PMID: 22878617    Free PMC article.
Intramammary lymph node metastases are an independent predictor of poor outcome in patients with breast carcinoma.
Jeannie Shen, Kelly K Hunt, +8 authors, Gildy V Babiera.
Cancer, 2004 Aug 19; 101(6). PMID: 15316905
Can diffusion-weighted imaging predict tumor grade and expression of Ki-67 in breast cancer? A multicenter analysis.
Alexey Surov, Paola Clauser, +6 authors, Andreas Wienke.
Breast Cancer Res, 2018 Jun 21; 20(1). PMID: 29921323    Free PMC article.
Apparent diffusion coefficient cannot predict molecular subtype and lymph node metastases in invasive breast cancer: a multicenter analysis.
Alexey Surov, Yun-Woo Chang, +4 authors, Andreas Wienke.
BMC Cancer, 2019 Nov 07; 19(1). PMID: 31690273    Free PMC article.
The volumetric-tumour histogram-based analysis of intravoxel incoherent motion and non-Gaussian diffusion MRI: association with prognostic factors in HER2-positive breast cancer.
Chao You, Jianwei Li, +4 authors, Weijun Peng.
J Transl Med, 2019 Jul 03; 17(1). PMID: 31262334    Free PMC article.
Peritumor to tumor apparent diffusion coefficient ratio is associated with biologically more aggressive breast cancer features and correlates with the prognostication tools.
Hidemi Okuma, Mazen Sudah, +7 authors, Ritva Vanninen.
PLoS One, 2020 Jun 26; 15(6). PMID: 32584887    Free PMC article.
Diffusion-Weighted Imaging in Oncology: An Update.
Carmelo Messina, Rodolfo Bignone, +13 authors, Domenico Albano.
Cancers (Basel), 2020 Jun 12; 12(6). PMID: 32521645    Free PMC article.
DW-MRI of the breast: a pictorial review.
Irmak Durur-Subasi.
Insights Imaging, 2019 Jun 05; 10(1). PMID: 31161458    Free PMC article.