Original Research Utility of diffusion-weighted imaging in differentiating benign and malignant breast lesions

Allen Johnson, Radha Sarawagi, Rajesh Malik, Jitendra Sharma, Abhinav Bhagat

South African Journal of Radiology | Vol 28, No 1 | a2952 | DOI: https://doi.org/10.4102/sajr.v28i1.2952 | © 2024 Allen Johnson, Radha Sarawagi, Rajesh Malik, Jitendra Sharma, Abhinav Bhagat | This work is licensed under CC Attribution 4.0
Submitted: 22 May 2024 | Published: 09 October 2024

About the author(s) Allen Johnson, Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
Radha Sarawagi, Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India
Rajesh Malik, Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India
Jitendra Sharma, Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India
Abhinav Bhagat, Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Bhopal, India

Abstract

Background: Breast cancer presents a significant global health burden. An accurate differentiation between benign and malignant lesions is imperative for timely intervention. While dynamic contrast enhanced MRI (DCE-MRI) is highly sensitive, its specificity is limited. This has led to the exploration of diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions.

Objectives: The study aimed to explore the diagnostic utility of DWI in distinguishing between benign and malignant breast lesions.

Method: Assessment of 38 breast lesions using DWI with a b value of 800 s/mm2, performed with 3 Tesla MRI. The diagnostic performance of two different region of Interest (ROI) placement approaches was compared to obtain a feasible cut-off value of apparent diffusion coefficient (ADC) to differentiate between malignant and benign lesions. The histopathological reports were used as the gold standard.

Results: ADC values of malignant lesions were significantly lower than those of benign lesions (0.84 × 10−3 mm2/s vs. 1.54 × 10−3 mm2/s). The average ADC measured using a small-sized 2D ROI including the darkest part in the ADC map, performed better than the large 2D ROI covering the entire lesion.

Conclusion: Using a cut-off value of 0.98 × 10−3 mm2/s, ADC obtained high sensitivity (90%) and specificity (88.9%) in distinguishing between benign and malignant breast lesions.

Contribution: Utilising quantitative analysis of DWI with ADC value measurement, reliably distinguished between benign and malignant breast lesions in this cohort, especially when employing a higher b value of 800 s/mm2.

Keywords

breast cancer; MRI; ADC; benign; malignant; BI-RADS; radiology.

Sustainable Development Goal

Goal 3: Good health and well-being

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