Comparison of automated breast ultrasonography to handheld ultrasonography in detecting and diagnosing breast lesions.

BACKGROUND: Automated breast ultrasonography (ABUS) is increasingly used as a screening tool. Several studies have demonstrated a similar diagnostic performance for ABUS compared with handheld ultrasonography (HHUS), but the overall results have been controversial. PURPOSE: To compare the clinical utility of ABUS and HHUS for detection and diagnosis of breast lesions. MATERIAL AND METHODS: ABUS and HHUS images of suspicious breast lesions were obtained for 173 consecutive women scheduled to undergo ultrasonography (US)-guided or stereotactic biopsy. There were a total of 206 lesions, 46 of which were malignant and 160 benign. Three breast radiologists took part in this study: two reviewed the ABUS images, and the third reviewed all of the images, ABUS and HHUS, as well as the patients' medical records. The biopsied-lesion-detection rates were obtained. Using the Breast Imaging Reporting and Data System (BI-RADS), the images of the biopsied lesions were evaluated. Factors affecting ABUS detectability were analyzed. RESULTS: The overall detection rates were 83.0% for ABUS and 94.2% for HHUS. Ten lesions were not detected on either HHUS or ABUS and these were microcalcifications (one malignancy and nine benign lesions). Of the 194 HHUS-detected lesions, 169 were detected by ABUS and 25 benign were not. ABUS less frequently detected lesions of smaller size as well as those of benign appearance and lower final-assessment category (P = 0.011 and P < 0.0001, respectively). CONCLUSION: ABUS detected all of the malignant lesions that were detected on HHUS. ABUS missed several smaller benign lesions.

Gel pad application for automated breast sonography.

The purpose of this study was to describe the technical aspects of gel pad application for automated breast sonography and to show its effects on pain relief, scan coverage, and image quality. Twenty patients underwent 2 sets of automated breast sonography with and without gel pad application and were then asked to provide feedback on the examination-related pain. Scan coverage and image quality were compared quantitatively and qualitatively. The degree of pain was significantly decreased after gel pad application (P < .0001). The scan coverage was expanded particularly at the mid-portion of the breast. Image quality was satisfactory without significant differences between the sets. Gel pad application for automated breast sonography is easy and provides significant pain relief. The scan coverage was expanded, while the image quality was maintained.

Who could benefit the most from using a computer-aided detection system in full-field digital mammography?

BACKGROUND: The computer-aided detection (CAD) system on mammography has the potential to assist radiologists in breast cancer screening. The purpose of this study is to evaluate the diagnostic performance of the CAD system in full-field digital mammography for detecting breast cancer when used by dedicated breast radiologist (BR) and radiology resident (RR), and to reveal who could benefit the most from a CAD application. METHODS: We retrospectively chose 100 image sets from mammographies performed with CAD between June 2008 and June 2010. Thirty masses (15 benign and 15 malignant), 30 microcalcifications (15 benign and 15 malignant), and 40 normal mammography images were included. The participating radiologists consisted of 7 BRs and 13 RRs. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for total, normal plus microcalcification and normal plus mass both with and without CAD use for each reader. We compared the diagnostic performance values obtained with and without CAD use for the BR and RR groups, respectively. The reading time reviewing one set of 100 images and time reduction with CAD use for the BR and RR groups were also evaluated. RESULTS: The diagnostic performance was generally higher in the BR group than in the RR group. Sensitivity improved with CAD use in the BR and RR groups (from 81.10 to 84.29% for BR; 75.38 to 77.95% for RR). A tendency for improvement in all diagnostic performance values was observed in the BR group, whereas in the RR group, sensitivity improved but specificity, PPV, and NPV did not. None of the diagnostic performance parameters were significantly different. The mean reading time was shortened with CAD use in both the BR and RR groups (111.6 minutes to 94.3 minutes for BR; 135.5 minutes to 109.8 minutes for RR). The mean time reduction was higher for the RR than that in the BR group. CONCLUSIONS: CAD was helpful for dedicated BRs to improve their diagnostic performance and for RRs to improve the sensitivity in a screening setting. CAD could be essential for radiologists by decreasing reading time without decreasing diagnostic performance.

Mammographic artifacts on full-field digital mammography.

This study investigates the incidence of full-field digital mammographic (FFDM) artifacts with three systems at two institutions and compares the artifacts between two detector types and two grid types. A total of 4,440 direct and 4,142 indirect FFDM images were reviewed by two radiologists, and artifacts were classified as patient related, hardware related, and software processing. The overall incidence of FFDM artifacts was 3.4% (292/8,582). Patient related artifacts (motion artifacts and skin line artifacts) were the most commonly detected types (1.7%). Underexposure among hardware related artifacts and high-density artifacts among software processing artifacts also were common (0.7 and 0.5%, respectively). These artifacts, specific to digital mammography, were more common with the direct detector type and the crossed air grid type than with the indirect type and linear grid type (p < 0.05). The most common mammographic artifacts on FFDM were patient related, which might be controlled by the instruction of a patient and technologist. Underexposure and high-density artifacts were more common with direct detector and crossed air type of grid.

Clinical significance of incidental finding of focal activity in the breast at 18F-FDG PET/CT.

OBJECTIVE: The purpose of this study was to determine the clinical significance of the incidental finding of hypermetabolic foci in the breast at (18)F-FDG PET/CT in patients with malignant disease other than breast cancer or during a screening examination. MATERIALS AND METHODS: The files of 13,897 women who underwent FDG PET/CT from November 2004 to October 2009 were retrospectively reviewed. Forty-eight patients with incidental breast uptake had undergone either tissue confirmation or clinical follow-up with additional sonographic imaging. The following four variables were evaluated: age, maximum standard uptake value (SUV(max)) of breast uptake at FDG PET, findings in the CT portion of PET/CT, and sonographic findings. Malignancy rates were calculated for each variable. RESULTS: Malignancy was diagnosed in 18 (37.5%) patients and a benign condition in 30 (62.5%) patients. Statistically significant differences in malignancy rate were found between the groups with SUV(max) less than 2 (24.2%) and the group with SUV(max) of 2 or greater (66.7%) and between the group with lesions in a BI-RADS ultrasound category lower than 4 (10.7%) and the group with lesions in category 4 or higher (75.0%) (p < 0.05). There was no significant difference in malignancy rates between the groups younger than 45 years (11.1%) and 45 years and older (53.3%) or between the group with lesions in a BI-RADS category lower than 4 (30.2%) and that with lesions in category 4 or higher (100%) on the CT portion of PET/CT. CONCLUSION: Incidental hypermetabolic foci in the breast may represent malignancy in as many as 37.5% of cases. The SUV(max) and sonographic findings can be useful for differentiating benign from malignant lesions.

Role of sonographic elastography in the differential diagnosis of axillary lymph nodes in breast cancer.

OBJECTIVES: The purpose of this study was to evaluate the diagnostic utility of sonographic elastography in differentiating reactive and metastatic axillary lymph nodes in breast cancer. METHODS: A total of 64 lymph nodes (reactive, n = 33; metastatic, n = 31) from 62 patients with breast cancer were examined by both B-mode sonography and elastography from April to July 2009. Two experienced radiologists retrospectively assessed B-mode sonograms by the sum of scores for 4 criteria: short diameter, shape, hilum, and cortical thickening. Elastographic images were given scores of 1 to 4 according to the percentage of high-elasticity areas in the lymph nodes. We compared the diagnostic performance of B-mode sonography, elastography, and combined examinations. We also calculated the strain ratio of the lymph node and subcutaneous fat tissue. RESULTS: The elasticity score for malignant lymph nodes (mean, 3.1) was higher than the score for benign lymph nodes (mean, 2.2; P < .0001). With a cutoff between elasticity scores of 2 and 3, elastography showed 80.7% sensitivity, 66.7% specificity, and 73.4% accuracy. With a cutoff between B-mode sonographic scores of 1 and 2, B-mode sonography showed 74.2% sensitivity and 78.8% specificity. Combined B-mode and elastographic sonography showed higher sensitivity (87.1%) than B-mode sonography alone. With a strain ratio cutoff point of 2.3, sensitivity was 82.8%, and specificity was 56.3%. CONCLUSIONS: Sonographic elastography may increase the sensitivity of B-mode sonography in the detection of metastatic axillary lymph nodes.

Metastases to the breast from extramammary malignancies−sonographic features.

PURPOSE: To evaluate the clinical and sonographic (US) features of metastatic tumors from extramammary malignancies to the breast. METHODS: This study included 23 patients with pathologically proven metastases in the breast. Two radiologists retrospectively analyzed the images from US (n = 23), mammography (n = 11), and MRI (n = 5) examinations according to BIRADS. RESULTS: Patients presented with a palpable mass or diffuse breast swelling (21/23) or were asymptomatic (2/23). Eighteen patients had solitary or multiple breast masses on US. The common US finding was an ovoid hypoechoic mass with a noncircumscribed margin. The final assessment categories were BIRADS 3 (probably benign finding) in 6 cases (25%) and BIRADS 4 (suspicious abnormality) in 18 cases (75%). In five patients, US displayed a diffuse infiltrative pattern without a focal lesion, which was categorized as BIRADS 4. CONCLUSIONS: Metastatic tumors in the breast have a wide range of sonographic appearances, with some resembling benign lesions. Any newly developed mass in a patient with a known history of extramammary malignancy, even with a probably benign US appearance, should undergo biopsy for pathologic confirmation.

Clinical and imaging characteristics of Polyimplant Prosthesis hydrogel breast implants.

OBJECTIVE: To describe the clinical and imaging characteristics of Polyimplant Prosthesis (PIP) hydrogel breast implants. METHODS: Seven patients with surgically confirmed 8 ruptured and 6 normal PIP hydrogel implants were enrolled in our study. We reviewed retrospectively the medical records and breast ultrasonographic and magnetic resonance imaging (MRI) findings of the patients. RESULTS: Breast asymmetry was the most common clinical feature of PIP hydrogel implant rupture. The main radiologic finding of ruptured implants was a significant fluid collection around the implant. All 4 intracapsular ruptures showed no significant collapse of the implants despite a large accumulation of fluid surrounding the ruptured implants on ultrasonography and MRI. Three extracapsular ruptures showed variable collapse of the implants, partial collapse in 1 implant and total collapse in 2 implants. One extracapsular rupture showed enlargement of the implant. Ultrasonography and MRI revealed hydrogel extension to the muscles and chest wall in all 4 extracapsular ruptures and extensive inflammation and fibrosis in 3 extracapsular ruptures. CONCLUSIONS: Polyimplant Prosthesis hydrogel implant rupture can be clinically silent. Knowledge of clinical and radiologic findings of the ruptured implants will be helpful in its diagnosis.

The clinical and imaging characteristics of breast cancers in patients with interstitial mammoplasty.

PURPOSE: The aims of this study are to demonstrate the clinical characteristics and various imaging findings of breast cancers in patients with interstitial mammoplasty. METHODS: A total of six patients, who had breast cancer and had received liquid silicone or paraffin injection for augmentation, were included in this study. Mammography, ultrasonography, dynamic breast MRI, and PET/CT were performed for 5, 3, 6, and 2 patients, respectively. The clinical course was reviewed, and the imaging findings were retrospectively evaluated according to the ACR BI-RADS atlas. RESULTS: The mean maximal diameter of the detected breast cancers on enhanced breast MRI was 5.5 cm (range 4.8-7.1 cm). Although the breast cancers were all of a large size, subjective breast symptoms exhibited in only four of six patients. Mammographic examinations exhibited variable associate findings such as skin thickening, ipsilateral volume increase, and increase densities, but could not demonstrate main breast masses. A few sonographic examinations exhibited masses with associate findings such as skin thickening. On breast MRI, enhancing breast cancers with associate findings were detected in all the patients. On PET-CT, breast cancers and distant metastases were detected. CONCLUSIONS: Breast cancers in these patients were detected at the advanced stage. Dynamic breast MRI was useful for detecting breast cancer in these patients. Mammography failed to demonstrate the breast cancer, but cancer detection was facilitated by associated findings: skin thickening, asymmetric volume increase, and increased density.

F-18 FDG PET/CT demonstration of thymoma followed by development of lung cancer.

It is well-known that thymoma can be associated with diverse extrathymic malignancies. The authors present a case of a 72-year-old man with myasthenia gravis in which F-18 FDG PET/CT demonstrated high FDG uptake in both an anterior mediastinal mass and a lung nodule. The FDG uptake in the lung nodule was significantly higher than that of the thymic lesion, which might suggest the possibility of a second development of lung cancer in this thymoma patient. Surgical resection was done for the 2 tumors, and histologic examination revealed anterior mediastinal thymoma and primary adenocarcinoma of the lung. This case demonstrates the potential usefulness of PET/CT in detecting and assessing the second extrathymic malignancy in a patient with thymoma.

Clinical Manifestations of Superior Mesenteric Venous Thrombosis in the Era of Computed Tomography.

PURPOSE: Thrombosis of the portal vein, known as pylephlebitis, is a rare and fatal complication caused by intraperitoneal infections. The disease progression of superior mesenteric venous thrombosis (SMVT) is not severe. This study aimed to determine the clinical features, etiology, and prognosis of SMVT. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 41 patients with SMVT from March 2000 to February 2017. We obtained a list of 305 patients through the International Classification of Disease-9 code system and selected 41 patients with SMVT with computed tomography. Data from the medical records included patient demographics, comorbidities, review of system, laboratory results, clinical courses, and treatment modalities. RESULTS: The causes of SMVT were found to be intraperitoneal inflammation in 27 patients (65.9%), malignancy in 7 patients (17.1%), and unknown in 7 patients (17.1%). Among the patients with intraperitoneal inflammation, 14 presented with appendicitis (51.9%), 7 with diverticulitis (25.9%), and 2 with ileus (7.4%). When comparing patients with and without small bowel resection, the differences in symptom duration, bowel enhancement and blood culture were significant (P=0.010, P=0.039, and P=0.028, respectively). CONCLUSION: SMVT, caused by intraperitoneal inflammation, unlike portal vein thrombosis including pylephlebitis, shows mild prognosis. In addition, rapid symptom progression and positive blood culture can be the prognostic factors related to extensive bowel resection. Use of appropriate antibiotics and understanding of disease progression can help improve the outcomes of patients with SMVT.

The radiological spectrum of orbital pathologies that involve the lacrimal gland and the lacrimal fossa.

CT and MRI are utilized to differentiate between different types of masses and to determine the extent of lesions involving the lacrimal gland and the fossa. Although many diseases that affect the lacrimal gland and fossa are specifically diagnosed by imaging, it is frequently very difficult to differentiate each specific disease on the basis of image characteristics alone due to intrinsic similarities. In lacrimal gland epithelial tumors, benign pleomorphic adenomas are seen most commonly with a well defined benign appearance, and a malignant adenoid cystic carcinoma is seen with a typical invasive malignant appearance. However, a malignant myoepithelial carcinoma is seen with a benign looking appearance. Lymphomatous lesions of the lacrimal gland include a broad spectrum ranging from reactive hyperplasia to malignant lymphoma. These lesions can be very difficult to differentiate both radiologically and pathologically. Generally, lymphomas tend to occur in older patients. The developmental cystic lesions found in the lacrimal fossa such as dermoid and epidermoid cysts can be diagnosed when the cyst involves the superior temporal quadrant of the orbit and manifests as a non-enhancing cystic mass and, in case of a lipoma, it is diagnosed as a total fatty mass. However, masses of granulocytic sarcoma and xanthogranuloma, as well as vascular masses, such as a hemangiopericytoma, are difficult to diagnose correctly on the basis of preoperative imaging findings alone. A careful clinical evaluation and moreover, a pathologic verification, are needed. In this pictorial review, the various imaging spectrums of pathologic masses involving the lacrimal gland and fossa are presented, along with appropriate anatomy and pathology reviews.

Detectability and Usefulness of Automated Whole Breast Ultrasound in Patients with Suspicious Microcalcifications on Mammography: Comparison with Handheld Breast Ultrasound.

PURPOSE: The purpose of this study was to prospectively evaluate the detectability and usefulness of automated whole breast ultrasound (AWUS) and to compare it with handheld breast ultrasound (HHUS) in cases with suspicious microcalcifications identified by mammography. METHODS: Forty-two patients with 43 suspicious microcalcifications (25 malignant and 18 benign) detected by mammography underwent AWUS, HHUS, and histol-ogic examination. With knowledge of the mammographic findings, HHUS was performed to assess the visibility of the microcalcifications and the presence of associated masses or ductal changes. Two radiologists reviewed the AWUS images in consensus using the same methods employed for HHUS. Detectability of AWUS was compared with that of HHUS and was correlated with histologic and mammographic findings. RESULTS: Of the 43 lesions, 32 (74.4%) were detectable by AWUS and 31 (72.1%) by HHUS. No significant differences in sensitivity were found between the two methods (p=0.998). AWUS detected 96% (24/25) of malignant microcalcifications and 44.4% (8/18) of benign microcalcifications. AWUS was more successful in the detection of malignant vs. benign lesions (96.0% vs. 44.4%, p=0.002), lesions >10 mm vs. ≤10 mm in size (86.7% [26/30] vs. 46.2% [6/13], p=0.009), lesions with a fine pleomorphic or linear shape vs. a round or amorphous or coarse heterogeneous shape (94.7% [18/19] vs. 58.3% [14/24], p=0.021), and lesions associated with a mass or architectural distortion vs. without obvious changes on mammography (100% [19/19] vs. 54.2% [13/24], p=0.022). CONCLUSION: Detectability of AWUS was comparable to that of HHUS in cases where suspicious microcalcifications were identified on mammography. Therefore, AWUS might be helpful in the performance of ultrasound-guided percutaneous procedures for highly suspicious microcalcifications.

A case of primary rectal angioleiomyoma: review of radiologic finding with histopathologic correlation.

Angioleiomyomas are benign smooth muscle tumors that originate from the tunica media of veins and arteries. They can occur anywhere in the body, but the preferential location of these tumors is the lower extremities. We describe a rare case of rectal angioleiomyoma and present our findings obtained by using computed tomography, magnetic resonance imaging, and histopathological analysis.

Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI.

PURPOSES: To evaluate the diagnostic value of diffusion-weighted MRI (DWI) and combination of conventional MRI and DWI to predict metastatic axillary lymph nodes in breast cancer. MATERIALS AND METHODS: Two hundred fifty-two breast cancer patients with 253 axillae were included. The morphological parameters on axial T2-weighted images without fat saturation and apparent diffusion coefficient (ADC) values were retrospectively analyzed. An independent t-test/chi-square test and receiver operating characteristics (ROC) curve analysis were used. RESULTS: On conventional MRI, short and long axis length, maximal cortical thickness, relative T2 value, loss of fatty hilum (p<0.001 for each), and eccentric cortical thickening (p<0.003) were statistically significantly different between the metastatic and nonmetastatic groups. The short axis to long axis ratio was not a statistically significant parameter. The ADC value was significantly different between the 2 groups, with an AUC that was higher than that of conventional MR parameters (AUC, 0.815; threshold, ≤0.986×10-3 mm(2)/sec; sensitivity, 75.8%; specificity, 83.9%). Using the adopted thresholds for each parameter, a total number of findings suggesting malignancy of 4 or higher was determined as the threshold, with high specificity (90.1%). CONCLUSION: Using conventional MRI and DWI, we can evaluate the axilla in breast cancer with high specificity.

Band-like interposing fat along large vessels: ultrasonographic pseudolesions of the breast.

OBJECTIVE: The aim of this study is to evaluate the clinical characteristics and ultrasonographic findings of band-like interposing fat as well as to identify additional approaches for its diagnosis. MATERIALS AND METHODS: This study included 26 confirmed cases of band-like interposing fat from June 2008 to June 2010. A retrospective analysis was performed to evaluate the clinical characteristics and ultrasonographic findings in these cases. Five radiologists analyzed the ultrasonographic findings, which correlated with the mammographic and MRI findings when available, according to Breast Imaging Reporting and Data System classification. RESULTS: None of the 26 patients had any symptoms. In 92.3% of the patients, the lesion was located in the upper outer quadrant of the breast. The mean distance of the lesion from the nipple was 2.4 ± 0.7 cm (1.1-4.5). The mean depth of the lesion from the skin was 1.3 ± 0.3 cm (0.8-2.1). The mean maximal length of the lesion was 0.8 ± 0.4 cm (0.3-1.8). The following were the most frequent ultrasonographic findings of lesions: irregular shape, not parallel orientation, indistinct margins, abrupt interface, hypoechogenicity, no posterior feature, no calcification, and presence of vascularity. The most frequent BI-RADS category was 4a. There were no suspicious findings on the mammography or MRI. CONCLUSION: Ultrasonographic findings may lead to misclassification of band-like interposing fat as a malignancy. A better understanding of the clinical and ultrasonographic characteristics of band-like interposing fat would facilitate its differentiation from a true mass.

Role of sonographic elastography in the differential diagnosis of papillary lesions in breast.

PURPOSE: The purpose of this study was to compare the diagnostic performance of elastography, conventional ultrasonography (US) and combined conventional US and elastography for differentiation of papillary breast lesions. MATERIALS AND METHODS: A total of 95 papillary lesions (69 benign, 20 atypical and 6 malignant) in 87 patients were examined with conventional US and elastography. We evaluated conventional US images according to the Breast Imaging Reporting and Data System and internal composition (solid vs. cystic) and elastographic images according to elasticity scores. We compared diagnostic performances of elastography, conventional US and the combined method. RESULTS: Areas under the receiver-operating curve were 0.794 for elastography, 0.875 for conventional US and 0.787 for the combined method. When the elasticity score cutoff was between 2 and 3, the sensitivity, specificity, positive predictive value and negative predictive value were 100, 55.1, 13 and 100 %, respectively. The combined method showed similar sensitivity (100 vs. 100 %) to and higher specificity (57.3 vs. 5.6 %) than conventional US alone. No significant difference was found in the elasticity scores of cystic papillary lesions according to pathology. CONCLUSION: Elastography improved the specificity of conventional US in differentiating between benign or atypical and malignant papillary breast lesions when it was combined with conventional US.

Role and clinical usefulness of elastography in small breast masses.

RATIONALE AND OBJECTIVES: The aim of this study was to evaluate and compare the diagnostic performance of elastography, B-mode ultrasound (US), and a combination of elastography and B-mode US for the differentiation of small breast masses. MATERIALS AND METHODS: A total of 315 breast masses < 1 cm (267 benign, 48 malignant) in 278 patients were examined with B-mode US and elastography. Histopathologic results were used as a reference standard. Two radiologists retrospectively evaluated the B-mode images according to the American College of Radiology Breast Imaging Reporting and Data System and elastographic images according to the elasticity scoring classification system proposed by Itoh et al and the strain ratio. B-mode US and elastography were combined according to the cutoff value. The diagnostic performance of B-mode US, elastography, and the combination of the two modalities was compared using receiver-operating characteristic curve analysis. RESULTS: The mean elasticity score for malignant masses (3.02 ± 1.33) was significantly higher than that for benign masses (1.72 ± 0.78) (P < .001). Areas under the receiver-operating characteristic curves were 0.616 for B-mode US, 0.784 for elasticity score, 0.668 for strain ratio, 0.727 for the combination of B-mode US and elasticity score, and 0.701 for the combination of B-mode US, elasticity score, and strain ratio. The sensitivity, specificity, positive predictive value, and negative predictive value were 93.8%, 51.7%, 25.9%, and 97.9%, respectively, when elasticity score and B-mode US were combined as follows: downgrade of B-mode US assessment category in cases with elasticity scores of 1, no change in cases with scores of 2 or 3, and upgrade in cases with scores of 4 or 5. CONCLUSION: Elasticity score alone showed the best diagnostic performance, but a combination of B-mode US and elasticity score may have predictive value for the differentiation of benign and malignant lesions <1 cm.

Diffusion-weighted imaging of breast cancer: correlation of the apparent diffusion coefficient value with prognostic factors.

PURPOSE: To evaluate the role of diffusion-weighted imaging (DWI) in the detection of breast cancers, and to correlate the apparent diffusion coefficient (ADC) value with prognostic factors. MATERIALS AND METHODS: Sixty-seven women with invasive cancer underwent breast MRI. Histological specimens were analyzed for tumor size and grade, and expression of estrogen receptors (ER), progesterone receptors, c-erbB-2, p53, Ki-67, and epidermal growth factor receptors. The computed mean ADC values of breast cancer and normal breast parenchyma were compared. Relationships between the ADC values and prognostic factors were determined using Wilcoxon signed rank test and Kruskal-Wallis test. RESULTS: DWI detected breast cancer as a hyperintense area in 62 patients (92.5 %). A statistically significant difference in the mean ADC values of breast cancer (1.09 +/- 0.27 x 10(-5) mm(2)/s) and normal parenchyma (1.59 +/- 0.27 x 10(-5) mm(2)/s) was detected (P < 0.0001). There were no correlations between the ADC value and prognostic factors. However, the median ADC value was lower in the ER-positive group than the ER negative group, and this difference was marginally significant (1.09 x 10(-5) mm(2)/s versus 1.15 x 10(-5) mm(2)/s, P = 0.053). CONCLUSION: The ADC value was a helpful parameter in detecting malignant breast tumors, but ADC value could not predict patient prognosis.