The Role of Apparent Diffusion Coefficient (ADC) in Differentiating Between Benign and Malignant Breast Lesions in a Sample of Iranian Women Diffusion weighted in breast MRI
Abstract
Background: Breast cancer is the most prevalent cancer among women, emphasizing the need for early detection and accurate diagnosis. This study investigates the role of the Apparent Diffusion Coefficient (ADC) in distinguishing between benign and malignant breast lesions using Magnetic Resonance Imaging (MRI) and Diffusion-Weighted Imaging (DWI). A retrospective cross-sectional study was conducted involving 96 patients with breast lesions who underwent MRI and DWI scans.
Methods: Patients were selected from among those who had MRI and DWI scans with b-values of 0, 800, and 1000 s/mm². ADC values were calculated by plotting the Region of Interest (ROI) and extracting corresponding values. Histological evaluations confirmed the diagnosis of the lesions. Statistical analyses included calculating accuracy, sensitivity, and specificity, along with Receiver Operating Characteristic (ROC) curve analysis to determine the optimal cut-off value.
Results: The ADC values demonstrated an accuracy of 92.5%, sensitivity of 93.2%, and specificity of 91.2% in differentiating between benign and malignant lesions. The ROC curve analysis established a cut-off value of 1.44 × 10⁻³ mm²/s for effective differentiation.
Conclusion: ADC values can serve as a reliable biomarker for distinguishing breast lesions, potentially reducing unnecessary biopsies for benign cases and aiding clinicians in treatment decisions. The integration of ADC measurements into clinical practice could enhance patient management in breast cancer. Further research is warranted to validate these findings and explore additional markers to improve diagnostic accuracy in breast cancer management.
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References
Dolatkhah R, Hosseinalifam M, Sanaat Z, Dolatkhah N, Dastgiri S. Molecular Epidemiology of Breast Cancer in Iran: A Review Article. Journal of Obstetrics, Gynecology and Cancer Research. 2023;8(5):422-30.
Roshandel G, Ghanbari-Motlagh A, Partovipour E, Salavati F, Hasanpour-Heidari S, Mohammadi G, et al. Cancer incidence in Iran in 2014: results of the Iranian National Population-based Cancer Registry. Cancer epidemiology. 2019;61:50-8.
Vostakolaei FA, Broeders MJ, Mousavi SM, Kiemeney LA, Verbeek AL. The effect of demographic and lifestyle changes on the burden of breast cancer in Iranian women: a projection to 2030. The Breast. 2013;22(3):277-81.
Chen X, Li W-l, Zhang Y-l, Wu Q, Guo Y-m, Bai Z-l. Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions. BMC cancer. 2010;10:1-11.
Aberle DR, Chiles C, Gatsonis C, Hillman BJ, Johnson CD, McClennan BL, et al. Imaging and cancer: research strategy of the American College of Radiology Imaging Network. Radiology. 2005;235(3):741-51.
Leung JW. Screening mammography reduces morbidity of breast cancer treatment. AJR American journal of roentgenology. 2005;184(5):1508-9.
Gundry KR. Breast Ultrasound: Indications and Findings. Clinical obstetrics and gynecology. 2016;59(2):380-93.
Wahab MAKA, Kareem HA, Hassan EE. The utility of diffusion weighted MRI and apparent diffusion coefficient in characterization of breast masses. The Egyptian Journal of Radiology and Nuclear Medicine. 2015;46(4):1257-65.
Blackledge MD, Leach MO, Collins DJ, Koh DM. Computed diffusion-weighted MR imaging may improve tumor detection. Radiology. 2011;261(2):573-81.
Jagannathan NR. Breast MR. NMR in biomedicine. 2009;22(1):1-2.
Kul S, Cansu A, Alhan E, Dinc H, Reis A, Can G. Contrast-enhanced MR angiography of the breast: Evaluation of ipsilateral increased vascularity and adjacent vessel sign in the characterization of breast lesions. AJR American journal of roentgenology. 2010;195(5):1250-4.
Cai H, Liu L, Peng Y, Wu Y, Li L. Diagnostic assessment by dynamic contrast-enhanced and diffusion-weighted magnetic resonance in differentiation of breast lesions under different imaging protocols. BMC cancer. 2014;14:366.
Iima M, Le Bihan D, Okumura R, Okada T, Fujimoto K, Kanao S, et al. Apparent diffusion coefficient as an MR imaging biomarker of low-risk ductal carcinoma in situ: a pilot study. Radiology. 2011;260(2):364-72.
Min Q, Shao K, Zhai L, Liu W, Zhu C, Yuan L, Yang J. Differential diagnosis of benign and malignant breast masses using diffusion-weighted magnetic resonance imaging. World journal of surgical oncology. 2015;13:32.
Chen X, Li WL, Zhang YL, Wu Q, Guo YM, Bai ZL. Meta-analysis of quantitative diffusion-weighted MR imaging in the differential diagnosis of breast lesions. BMC cancer. 2010;10:693.
Guatelli CS, Bitencourt AGV, Osorio C, Graziano L, de Castro AA, de Souza JA, et al. Can diffusion-weighted imaging add information in the evaluation of breast lesions considered suspicious on magnetic resonance imaging? Radiologia brasileira. 2017;50(5):291-8.
Partridge SC, DeMartini WB, Kurland BF, Eby PR, White SW, Lehman CD. Quantitative diffusion-weighted imaging as an adjunct to conventional breast MRI for improved positive predictive value. AJR American journal of roentgenology. 2009;193(6):1716-22.
Yabuuchi H, Matsuo Y, Sunami S, Kamitani T, Kawanami S, Setoguchi T, et al. Detection of non-palpable breast cancer in asymptomatic women by using unenhanced diffusion-weighted and T2-weighted MR imaging: comparison with mammography and dynamic contrast-enhanced MR imaging. European radiology. 2011;21(1):11-7.
Surov A, Meyer HJ, Wienke A. Can apparent diffusion coefficient (ADC) distinguish breast cancer from benign breast findings? A meta-analysis based on 13 847 lesions. BMC cancer. 2019;19:1-14.
Iima M, Kataoka M, Honda M, Le Bihan D. Diffusion-Weighted MRI for the Assessment of Molecular Prognostic Biomarkers in Breast Cancer. Korean Journal of Radiology. 2024;25(7):623.
Dkhar W, Kadavigere R, Sukumar S, Pradhan A, Sharath S. Diagnostic Performances of ADC Value in Diffusion-Weighted MR Imaging for Differential Diagnosis of Breast Lesions in 1.5 T: A Systematic Review and Meta-analysis. Journal of Medical and Biological Engineering. 2023;43(5):497-507.
Abdulghaffar W, Tag-Aldeen MM. Role of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) in differentiating between benign and malignant breast lesions. Egypt J Radiol Nucl Med. 2013;44(4):945-51.
Cabuk G, Nass Duce M, Ozgur A, Apaydin FD, Polat A, Orekici G. The diagnostic value of diffusion-weighted imaging and the apparent diffusion coefficient values in the differentiation of benign and malignant breast lesions. Journal of medical imaging and radiation oncology. 2015;59(2):141-8.
Rinaldi P, Giuliani M, Belli P, Costantini M, Romani M, Distefano D, et al. DWI in breast MRI: role of ADC value to determine diagnosis between recurrent tumor and surgical scar in operated patients. European journal of radiology. 2010;75(2):e114-23.
Park MJ, Cha ES, Kang BJ, Ihn YK, Baik JH. The role of diffusion-weighted imaging and the apparent diffusion coefficient (ADC) values for breast tumors. Korean journal of radiology. 2007;8(5):390-6.
Mori N, Ota H, Mugikura S, Takasawa C, Tominaga J, Ishida T, et al. Detection of invasive components in cases of breast ductal carcinoma in situ on biopsy by using apparent diffusion coefficient MR parameters. European radiology. 2013;23(10):2705-12.
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