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Apparent diffusion coefficient in differentiation between malignant and benign breast masses: does size matter?

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Apparent diffusion coefficient (ADC) MRI is useful for characterizing breast masses, especially those hypointense on T2-weighted images. However, diagnostic performance for smaller lesions (≤ 1 cm) shows lower sensitivity and specificity.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Breast mass evaluation relies on imaging techniques to differentiate benign from malignant lesions.
  • Apparent diffusion coefficient (ADC) measurements from diffusion-weighted magnetic resonance imaging (MRI) offer insights into tissue cellularity and water diffusion.
  • Lesion size may influence the accuracy of ADC in breast mass characterization.

Purpose of the Study:

  • To investigate the impact of lesion size on the diagnostic performance of apparent diffusion coefficient (ADC) in differentiating benign from malignant breast masses.
  • To assess the sensitivity and specificity of ADC measurements for breast lesions of different sizes.

Main Methods:

  • Retrospective review of consecutive breast lesions identified via MRI between June 2010 and July 2013.
  • Comparison of ADC values between benign and malignant lesions.
  • Receiver operating characteristic (ROC) analysis to evaluate diagnostic performance based on lesion size (≤ 1 cm vs. >1 cm) and T2-weighted (T2W) signal intensities.

Main Results:

  • The study included 95 breast lesions: 74 malignant and 21 benign.
  • Mean ADC was significantly lower in malignant lesions (0.89 × 10(-3) mm(2)/s) compared to benign lesions (1.27 × 10(-3) mm(2)/s) (p<0.01).
  • For lesions >1 cm, an ADC cut-off of 1.088 × 10(-3) mm(2)/s yielded 85.9% sensitivity and 77% specificity. For lesions ≤ 1 cm, sensitivity dropped to 60% and specificity to 50%.

Conclusions:

  • Diffusion-weighted MRI, particularly ADC values, is valuable for characterizing breast masses, especially those with low T2-weighted signal intensity.
  • Diagnostic performance of ADC is reduced for smaller breast lesions (≤ 1 cm), necessitating careful interpretation.
  • Further research may explore optimized ADC thresholds or complementary imaging parameters for small lesion characterization.