Eun Kyung Park MD, Presenter: Nothing to Disclose

Kyu Ran Cho MD, PhD, Abstract Co-Author: Nothing to Disclose

Bo Kyoung Seo MD, PhD, Abstract Co-Author: Nothing to Disclose

Ok Hee Woo MD, Abstract Co-Author: Nothing to Disclose

Sung Bum Cho, Abstract Co-Author: Nothing to Disclose

Kyung Hwa Park, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to investigate the diagnostic value of an imaging protocol that addition of diffusion-weighted imaging (DWI) to dynamic contrast-enhanced breast MRI (DCE-MRI) for diagnosis multifocal and multicentric breast cancer.

The prospective study included 82 consecutive women with 136 enhancing lesions on DCE-MRI for preoperative staging in breast cancer. Morphologic and kinetic assessments were performed on DCE-MRI and findings were classified according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon. Apparent diffusion coefficient (ADC) values were compared for benign and malignant lesions. For the combined MRI protocol, lesions which were classified as BI-RADS 4a and had an ADC value more than the calculated cutoff value were considered as benign. Sensitivity (SE), specificity (SP) and positive predictive value (PPV) were evaluated for DCE-MRI alone and combined MRI protocol for unexpected additionally detected lesions on DCE-MRI. Results were further compared by lesion size (>1cm or ≤1cm).

Of the 136 lesions, 26 were benign and 110 were malignant (15 ductal carcinoma in situ, 95 invasive carcinoma). The malignant lesions (mean ADC, 0.93±0.22×10-3 mm2/s) exhibited lower mean ADC than benign lesions (1.20±0.24×10-3 mm2/s, P <0.01). Of the 136 lesions, 49 lesions were additionally detected lesions on DCE-MRI. DCE-MRI alone showed 97% SE, 18% SP, and 69% PPV. The combined MRI protocol produced 97% SE, 71% SP, and 86% PPV, and showed statistically significant increase of SP (P <0.01) and PPV (P=0.02). PPV of combined MRI protocol for larger lesions (100%) was higher than that of smaller lesions (76%), however, combined DWI increased PPV similarly for larger lesions and small lesions.

The combined DWI to DCE-MRI has the potential to increase the SP and PPV to diagnose multifocal and multicentric breast cancer.

The addition of DWI can decrease the false positive diagnosis and this is recommended in preoperative staging of breast cancer.

Park, E, Cho, K, Seo, B, Woo, O, Cho, S, Park, K, Usefulness of Combined Diffusion-weighted Imaging to Dynamic Contrast-enhanced Breast MRI for Diagnosis of the Multifocal and Multicentric Breast Cancer.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045726.html