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Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using pre-operative breast MRI

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Abstract

Objectives

To investigate whether diffusion-weighted imaging (DWI) aids pre-operative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate additional lesions in breast cancer patients.

Methods

DCE-MRI and DWI were performed on 131 lesions, with available histopathological results. The apparent diffusion coefficient (ADC) of each lesion was measured, and the cut-off value for differentiation between malignant and benign lesions was calculated. A protocol combining the ADC cut-off value with DCE-MRI was validated in a cohort of 107 lesions in 77 patients.

Results

When an ADC cut-off value of 1.11 × 10-3 mm2/s from the development cohort was applied to the additional lesions in the validation cohort, the specificity increased from 18.9% to 67.6% (P < 0.001), and the diagnostic accuracy increased from 61.7% to 82.2% (P = 0.05), without significant loss of sensitivity (98.6% vs. 90.0%, P = 0.07). The negative predictive values of lesions in the same quadrant had decreased, as had those of lesions ≥1 cm in diameter. The ADC cut-off value in the validation cohort was 1.05 × 10-3 mm2/s.

Conclusions

Additional implementation of DWI for breast lesions in pre-operative MRI can help to obviate unnecessary biopsies by increasing specificity. However, to avoid missing cancers, clinicians should closely monitor lesions located in the same quadrant or lesions ≥1 cm.

Key Points

• DWI can be used to further differentiate lesions during pre-operative cancer staging.

• ADC cut-off values were similar in the development and validation cohorts.

• DWI improves both PPV and NPV in cases of multicentric lesions.

• DWI improves both PPV and NPV in lesions <1 in diameter.

• NPVs are decreased in multifocal lesions and lesions ≥1 cm in diameter.

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Authors and Affiliations

  1. Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea

    Sung Eun Song, Eun Kyung Park, Kyu Ran Cho & Sung Bum Cho

  2. Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea

    Bo Kyoung Seo

  3. Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea

    Ok Hee Woo

  4. Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

    Seung Pil Jung

Authors
  1. Sung Eun Song
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  2. Eun Kyung Park
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  3. Kyu Ran Cho
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  4. Bo Kyoung Seo
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  5. Ok Hee Woo
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  7. Sung Bum Cho
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Corresponding author

Correspondence to Kyu Ran Cho.

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Guarantor

The scientific guarantor of this publication is Kyu Ran Cho.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

Additional information

Sung Eun Song and Eun Kyung Park contributed equally to this work.

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Song, S.E., Park, E.K., Cho, K.R. et al. Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using pre-operative breast MRI. Eur Radiol 27, 4819–4827 (2017). https://doi.org/10.1007/s00330-017-4898-5

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  • DOI: https://doi.org/10.1007/s00330-017-4898-5

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