Journal Article
. 2020 Apr; 10:332.
doi: 10.3389/fonc.2020.00332.

Differentiation of Breast Lesions and Distinguishing Their Histological Subtypes Using Diffusion-Weighted Imaging and ADC Values

Jelena Maric 1 Jasmina Boban 2 Tatjana Ivkovic-Kapicl 2 Dragana Djilas 2 Viktorija Vucaj-Cirilovic 2 Dragana Bogdanovic-Stojanovic 2 
  • PMID: 32232007
  •     29 References


Diffusion-weighted imaging (DWI) has not been well explored in differentiation of malignant from benign breast lesions. The aims of this study were to examine the role of apparent diffusion coefficient (ADC) values in differentiation of malignant from benign tumors and distinguishing histological subtypes of malignant lesions, and to determine correlations between ADC values and breast tumors structure. This cohort-study included 174 female patients who underwent contrast-enhanced breast MR examination on a 3T scanner and were divided into two groups: patient group (114 patients with proven tumors) and control group (60 healthy patients). One-hundred-thirty-nine lesions (67 malignant and 72 benign) were detected and pathohistologically analyzed. Differences between variables were tested using chi-square test; correlations were determined using Pearson's correlation test. For determination of cut off values for diagnostic potential, Receiver Operating Characteristic curves were constructed. Statistical significance was set at p < 0.05. Mean ADC values were significantly lower in malignant compared to benign lesions (0.68 × 10-3mm2/s vs. 1.12 × 10-3mm2/s, p < 0.001). The cut off value of ADC for benign lesions was 0.792 × 10-3mm2/s (sensitivity 98.6%, specificity 65.7%), and for malignant 0.993 × 10-3mm2/s (98.5, 80.6%). There were no significant correlations between malignant lesion subtypes and ADC values. DWI is a clinically useful tool for differentiation of malignant from benign lesions based on mean ADC values. The cut off value for benign lesions was higher than reported recently, due to high amount of fibrosis in included benign lesions. Finally, ADC values might have implications in determination of the biological nature of the malignant lesions.

Keywords: ADC values; Diffusion-weighted (DW) imaging; breast cancer; differentiation; magnetic resonance imaging.

Abbreviated breast magnetic resonance imaging (MRI): first postcontrast subtracted images and maximum-intensity projection-a novel approach to breast cancer screening with MRI.
Christiane K Kuhl, Simone Schrading, +3 authors, Heribert B Bieling.
J Clin Oncol, 2014 Jun 25; 32(22). PMID: 24958821
Highly Cited.
Abbreviated MRI Protocols: Wave of the Future for Breast Cancer Screening.
Chloe M Chhor, Cecilia L Mercado.
AJR Am J Roentgenol, 2016 Nov 05; 208(2). PMID: 27809564
Improved diagnostic accuracy of breast MRI through combined apparent diffusion coefficients and dynamic contrast-enhanced kinetics.
S C Partridge, H Rahbar, +4 authors, C D Lehman.
Magn Reson Med, 2011 Jan 22; 65(6). PMID: 21254208    Free PMC article.
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
American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version).
M Elizabeth H Hammond, Daniel F Hayes, +31 authors, College of American Pathologists.
Arch Pathol Lab Med, 2010 Jul 01; 134(7). PMID: 20586616
Highly Cited. Systematic Review.
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
BI-RADS update.
Cecilia L Mercado.
Radiol Clin North Am, 2014 May 06; 52(3). PMID: 24792650
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.
Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI.
Eun Jeong Kim, Sung Hun Kim, +3 authors, Jae Jeong Choi.
Magn Reson Imaging, 2014 Jul 30; 32(10). PMID: 25072504
Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions.
Tuğba Bozkurt Bostan, Gonca Koç, +3 authors, Orhan Oyar.
Balkan Med J, 2016 Jun 17; 33(3). PMID: 27308073    Free PMC article.
Diffusion-weighted half-Fourier single-shot turbo spin echo imaging in breast tumors: differentiation of invasive ductal carcinoma from fibroadenoma.
Takahiro Kinoshita, Naobumi Yashiro, +3 authors, Makoto Narita.
J Comput Assist Tomogr, 2002 Dec 19; 26(6). PMID: 12488758
Diffusion-Weighted Imaging of Breast Cancer: Correlation of the Apparent Diffusion Coefficient Value with Pathologic Prognostic Factors.
Şehnaz Tezcan, Nihal Uslu, +2 authors, Tugan Tezcaner.
Eur J Breast Health, 2019 Oct 18; 15(4). PMID: 31620686    Free PMC article.
Diffusion-weighted imaging of the breast: principles and clinical applications.
Reiko Woodhams, Saadallah Ramadan, +5 authors, Yusuke Inoue.
Radiographics, 2011 Jul 20; 31(4). PMID: 21768239
Quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesion.
C Marini, C Iacconi, +3 authors, C Bartolozzi.
Eur Radiol, 2007 Mar 16; 17(10). PMID: 17356840
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
Reconsideration of clinical and histopathological prognostic factors in breast cancer patients: a single center experience.
Ozgur Tanriverdi, Nezih Meydan, Sabri Barutca.
Asian Pac J Cancer Prev, 2014 Feb 27; 15(2). PMID: 24568500
Diffusion weighted magnetic resonance imaging of the breast: protocol optimization, interpretation, and clinical applications.
Savannah C Partridge, Elizabeth S McDonald.
Magn Reson Imaging Clin N Am, 2013 Aug 10; 21(3). PMID: 23928248    Free PMC article.
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.
Tumour cellularity, oestrogen receptors and prognosis in breast cancer.
R Black, R Prescott, +3 authors, P Forrest.
Clin Oncol, 1983 Dec 01; 9(4). PMID: 6661854
A Brief Overview of the WHO Classification of Breast Tumors, 4th Edition, Focusing on Issues and Updates from the 3rd Edition.
Hans-Peter Sinn, Hans Kreipe.
Breast Care (Basel), 2014 Jan 15; 8(2). PMID: 24415964    Free PMC article.
Differentiation of clinically benign and malignant breast lesions using diffusion-weighted imaging.
Yong Guo, You-Quan Cai, +5 authors, Jia-Hong Gao.
J Magn Reson Imaging, 2002 Aug 31; 16(2). PMID: 12203765
Highly Cited.
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
Multiparametric MR Imaging of Breast Cancer.
Habib Rahbar, Savannah C Partridge.
Magn Reson Imaging Clin N Am, 2015 Nov 29; 24(1). PMID: 26613883    Free PMC article.
Differences in morphological features and minimum apparent diffusion coefficient values among breast cancer subtypes using 3-tesla MRI.
Fumi Kato, Kohsuke Kudo, +6 authors, Hiroki Shirato.
Eur J Radiol, 2016 Jan 03; 85(1). PMID: 26724653
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
Apparent diffusion coefficient value measurements with diffusion magnetic resonance imaging correlated with the expression levels of estrogen and progesterone receptor in breast cancer: A meta-analysis.
Lin Meng, Ping Ma.
J Cancer Res Ther, 2016 Apr 14; 12(1). PMID: 27072207
Mechanism of contrast enhancement in breast lesions at MR imaging.
B Boné, M K Wiberg, +3 authors, A Gad.
Acta Radiol, 1998 Oct 02; 39(5). PMID: 9755697
Evaluation of the prognostic role of vascular endothelial growth factor and microvessel density in stages I and II breast cancer patients.
V Ludovini, A Sidoni, +13 authors, M Colozza.
Breast Cancer Res Treat, 2003 Oct 24; 81(2). PMID: 14572158
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