Optimizing ADC Values for Distinguishing Between Benign and Malignant Breast Lesions

Firas Abdullah Noori  Al-Baghdadi

Firas Abdullah Noori Al-Baghdadi M.B.Ch.B., F.I.C.M.S., Radiology, Assistant Professor, Radiology Specialist, Department of Surgery, College of Medicine, University of Thi-Qar, Thi-Qar, Iraq

Keywords: Breast lesions, Diagnostic, DWI, NPV, Sensitivity, DCE-MRI, PPV, Benign, Malignant

Abstract

The review was a cross-sectional survey of breast lesions in ladies from Al-Imam Al-Hussein Teaching Hospital, Nasiriyah, Iraq, directed between April 2022 and July 2023. The patients were examined with ultrasound and mammogram and went through MRI evaluations utilizing a 1.5 Tesla MR unit. The outcomes were assessed as per the American School of Radiology BI-RADS breast imaging dictionary. A sum of 38 patients were remembered for the review, with a sum of 46 injuries. All lesions went through histopathological findings, which was viewed as the best quality level for the review. The ideal cutoff value was <1.232x10^-3 mm²/s, displaying a sensitivity of 100 percent, specificity of 90%, a positive predictive value (PPV) of 92%, a negative predictive value (NPV) of 100 percent, and an accuracy rate of 95.7%. The DCE-MRI exhibited a sensitivity of 96%, a specificity of 85%, a positive predictive value (PPV) of 89%, a negative predictive value (NPV) of 94%, and an accuracy rate of 91.3%. The combined examination of a contrast-enhanced DCE-MRI and diffusion-weighted imaging (DWI) brought about an increment of 4% in the sensitivity and the specificity by 10 %. The addition of DWI to the standard breast MRI has a sensitivity of 100%, a specificity of 95%, a positive predictive value (PPV) of 96%, a negative predictive value (NPV) of 100%, and an accuracy rate of 97.8%. These outcomes show that DWI is an important instrument for portraying breast lesions.

References

P. D. Sasieni, J. Shelton, N. Ormiston-Smith, C. S. Thomson, and P. B. Silcocks, "What is the lifetime risk of developing cancer? The effect of adjusting for multiple primaries," Br. J. Cancer., vol. 105, pp. 460-465, 2011, doi: 10.1038/bjc.2011.250.

H. Sung, J. Ferlay, R. L. Siegel, M. Laversanne, I. Soerjomataram, A. Jemal, and F. Bray, "Global Cancer Statistics 2020: Globocan Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries," CA Cancer J. Clin., vol. 71, pp. 209-249, 2021, doi: 10.3322/caac.21660.

S. Paepke, S. Metz, A. B. Salvago, and R. Ohlinger, "Benign Breast Tumours—Diagnosis and Management," Breast Care, vol. 13, pp. 403-412, 2018, doi: 10.1159/000495919.

A. Stachs, J. Schubert, T. Reimer, and S. Hartmann, "Benign Breast Disease in Women," Dtsch. Arztebl. Int., vol. 116, pp. 565-574, 2019, doi: 10.3238/arztebl.2019.0565.

R. M. Mann, C. Balleyguier, P. A. Baltzer, U. Bick, C. Colin, E. Cornford, A. N. Evans, E. M. Fallenberg, G. Forrai, M. H. Fuchsjäger, et al., "Breast MRI: EUSOBI recommendations for women’s information," Eur. Radiol., vol. 25, pp. 3669-3678, 2015, doi: 10.1007/s00330-015-3807-z.

R. M. Mann, N. Cho, and L. Moy, "Breast MRI: State of the Art," Radiology, vol. 292, pp. 520-536, 2019, doi: 10.1148/radiol.2019182947.

P. Clauser, B. Krug, H. Bickel, M. Dietzel, K. Pinker, V. F. Neuhaus, M. A. Marino, M. Moschetta, N. Troiano, T. H. Helbich, et al., "Diffusion-weighted Imaging Allows for Downgrading MR BI-RADS 4 Lesions in Contrast-enhanced MRI of the Breast to Avoid Unnecessary Biopsy," Clin. Cancer Res., vol. 27, pp. 1941-1948, 2021, doi: 10.1158/1078-0432.CCR-20-3037.

S. Y. Choi, Y. W. Chang, H. J. Park, et al., "Correlation of the Apparent Diffusion Coefficient Values on Diffusion-Weighted Imaging with Prognostic Factors for Breast Cancer," Br. J. Radiol., vol. 85, no. 1016, pp. 102-108, 2012.

S. C. Partridge, C. D. Mullins, B. F. Kurland, M. D. Allain, W. B. DeMartini, P. R. Eby, et al., "Apparent Diffusion Coefficient Lesions: Effects of Lesion Type and Size," AJR Am J Roentgenol., vol. 194, pp. 1664-1673, 2010.

M. Tozaki and K. Fukuda, "High-Spatial-Resolution MRI of Non-Masslike Breast Lesions: Interpretation Model Based on BI-RADS MRI Descriptors," AJR Am J Roentgenol., vol. 187, pp. 330-337, 2006.

C. I. Li, D. J. Uribe, and J. R. Daling, "Clinical Characteristics of Different Histological Types of Breast Cancer," Br. J. Cancer., vol. 93, no. 9, pp. 1046-1052, 2005.

H. Al-Khawari, R. Athyal, A. Kovacs, et al., "Accuracy of the Fischer Scoring System and the Breast Imaging Reporting and Data System in the Identification of Malignant Breast Lesions," Hematol Oncol Stem Cell Ther., vol. 2, no. 3, pp. 403-410, 2009.

L. Liberman, E. A. Morris, M. J. Lee, et al., "Breast Lesions Detected on MR Imaging: Features and Positive Predictive Value," AJR Am J Roentgenol., vol. 179, pp. 171-178, 2002.

L. Liberman, E. A. Morris, D. D. Dershaw, A. F. Abramson, and L. K. Tan, "Ductal Enhancement on MR Imaging of the Breast," AJR Am J Roentgenol., vol. 181, pp. 519-525, 2003.

A. Matsuoka, M. Minato, M. Harada, H. Kubo, Y. Bandou, A. Tangoku, et al., "Comparison of 3.0- and 1.5-T DWI in the Visibility of Breast Cancer," Radiat Med., vol. 26, no. 1, pp. 15-20, 2008.

S. C. Partridge, N. Nissan, H. Rahbar, A. E. Kitsch, and E. E. Sigmund, "Diffusion-Weighted Breast MRI: Clinical Applications and Emerging Techniques," J. Magn. Reson. Imaging., vol. 45, pp. 337-355, 2017, doi: 10.1002/jmri.25479.

R. Woodhams, K. Matsunaga, K. Iwabuchi, S. Kan, H. Hata, M. Kuranami, M. Watanabe, and K. Hayakawa, "Diffusion-Weighted Imaging of Malignant Breast Tumors: The Usefulness of Apparent Diffusion Coefficient (ADC) Value and ADC Map for the Detection of Malignant Breast Tumors and Evaluation of Cancer Extension," J. Comput. Assist. Tomogr., vol. 29, pp. 644-649, 2005, doi: 10.1097/01.rct.0000171913.74086.1b.

E. A. Azab and M. E. Ibrahim, "Diffusion-Weighted (DW) MRI Role in the Characterization of Breast Lesions Using Absolute and Normalized ADC Values," Egypt. J. Radiol. Nucl. Med., vol. 47, pp. 564-570, 2018, doi: 10.1016/j.ejrnm.2018.01.009.

H. Okuma, M. Sudah, T. Kettunen, A. Niukkanen, A. Sutela, A. Masarwah, V.-M. Kosma, P. Auvinen, A. Mannermaa, and R. Vanninen, "Peritumor to Tumor Apparent Diffusion Coefficient Ratio is Associated with Biologically More Aggressive Breast Cancer Features and Correlates with the Prognostication Tools," PLoS ONE, vol. 15, p. e0235278, 2020, doi: 10.1371/journal.pone.0235278.

A. Surov, P. Clauser, Y. W. Chang, L. Li, L. Martincich, S. C. Partridge, J. Y. Kim, H. J. Meyer, and A. Wienke, "Can Diffusion-Weighted Imaging Predict Tumor Grade and Expression of Ki-67 in Breast Cancer? A Multicenter Analysis," Breast Cancer Res., vol. 20, p. 58, 2018, doi: 10.1186/s13058-018-0991-1.