Additional value of diffusion-weighted imaging to evaluate multifocal and multicentric breast cancer detected using pre-operative breast MRI.
Eur Radiol
; 27(11): 4819-4827, 2017 Nov.
Article
en En
| MEDLINE
| ID: mdl-28593433
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Neoplasias de la Mama
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Cuidados Preoperatorios
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Imagen por Resonancia Magnética
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Imagen de Difusión por Resonancia Magnética
Tipo de estudio:
Diagnostic_studies
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Guideline
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Observational_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Middle aged
Idioma:
En
Revista:
Eur Radiol
Asunto de la revista:
RADIOLOGIA
Año:
2017
Tipo del documento:
Article