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Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation

Risonanza magnetica in diffusione nella tipizzazione delle lesioni focali della mammella: analisi di 78 casi sottoposti a controllo anatomopatologico

  • Breast Radiology / Senologia
  • Published:
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Abstract

Purpose

This study assessed the usefulness of magnetic resonance diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions.

Materials and methods

Gadolinium-enhanced magnetic resonance imaging (MRI) and DWI with determination of the apparent diffusion coefficient (ADC) were performed on 78 women, each with a focal breast lesion at least 7 mm in diameter, which was studied by cytology or histology.

Results

Final diagnoses were obtained by cytology in 29 cases and histology in 49 (11 percutaneous biopsies and 38 surgical specimens). There were 43 benign lesions (13 fibrocystic disease, eight fibroadenoma, seven adenosis, five normal breast tissue, four inflammatory lesions, three intramammary lymph nodes, two scleroelastosis and one fat necrosis) and 35 malignant lesions (30 invasive ductal carcinoma, two invasive lobular carcinoma, one ductal carcinoma in situ, one carcinomatous mastitis and one metastasis from neuroendocrine carcinoma). The mean ADC values were 1.677±0.151 for benign lesions and 1.298±0.129 for malignant lesions (p<0.001). With an ADC cutoff value of 1.48, DWI had 88.6% sensitivity [confidence interval (CI) 78.1%–99.1%] and 95.3% specificity (CI 88.9%–100%), with 31 true positives, four false negatives (three invasive ductal carcinoma and one carcinomatous mastitis), 41 true negatives and two false positives (one fat necrosis and one fibroadenoma). With the cutoff value set at 1.52, DWI sensitivity (35 true positive, no false negative) was 100% and specificity was 86% (CI 75.7%–96.3%) due to 37 true negatives and six false positives (an additional two fibroadenoma and two fibrocystic disease compared with those recorded with the cutoff set at 1.48). The overall accuracy of DWI considering both cutoff values (72 correct evaluations out of 78 cases) was 92.3% (CI 86.4%–98.2%).

Conclusions

DWI is a reliable tool for characterising focal breast lesions.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato stabilire l’utilità dell’imaging in risonanza magnetica (RM) pesata in diffusione (DWI) nel distinguere le lesioni mammarie benigne da quelle maligne.

Materiali e metodi

La RM con mezzo di contrasto e la DWI, con misurazione del coefficiente di diffusione apparente (ADC), sono state eseguite in 78 pazienti di sesso femminile, ognuna portatrice di una lesione focale della mammella con diametro di almeno 7 mm sottoposta ad indagine citologica o bioptica.

Risultati

La diagnosi finale è stata ottenuta mediante citologia in 29 casi ed istologia in 49 (11 biopsie percutanee e 38 pezzi operatori). 43 lesioni sono risultate benigne (13 casi di mastopatia fibrocistica, 8 di fibroadenoma, 7 di adenosi, 5 di tessuto mammario normale, 4 di lesioni flogistiche, 3 di linfonodi intramammari, 2 di scleroelastosi ed 1 di steatonecrosi) e 35 maligne (30 carcinomi duttali infiltranti, 2 carcinomi lobulari infiltranti, 1 carcinoma duttale in situ, 1 mastite carcinomatosa ed 1 metastasi da carcinoma neuroendocrino). I valori medi di ADC sono risultati di 1,677±0,151 per le lesioni benigne e di 1,298±0,129 per quelle maligne (p<0,001). Ponendo il cut off di ADC pari a 1,48, la DWI ha raggiunto una sensibilità (31 veri positivi; 4 falsi negativi, rappresentati da 3 carcinomi duttali infiltranti e da una mastite carcinomatosa) dell’88,6% (intervallo di confidenza [IC]: 78,1%–99,1%) ed una specificità (41 veri negativi; 2 falsi positivi, dovuti ad un caso di steatonecrosi e ad un fibroadenoma) del 95,3% (IC: 88,9%–100%). Con il cut off di 1,52, la sensibilità (35 veri positivi; nessun falso negativo) è risultata del 100% e la specificità (37 veri negativi; 6 falsi positivi, per l’aggiunta ai due falsi positivi riscontrati con cut off di 1,48 di 2 fibroadenomi e 2 casi di mastopatia fibrocistica) dell’86% (IC: 75,7%–96,3%). Con entrambi i cut off l’accuratezza globale della DWI (72 risultati esatti su 78 casi) è stata del 92,3% (IC: 86,4%–98,2%).

Conclusioni

La DWI è uno strumento affidabile nella tipizzazione delle lesioni focali mammarie.

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Authors and Affiliations

  1. Department of Radiology, Ospedale Scaligero Veronese, Via Fontanelle, 1, 37047, S. Bonifacio, Verona, Italy

    F. Fornasa, L. Pinali, A. Gasparini & E. Toniolli

  2. Department of Radiology, Ospedale Civile Maggiore, P.le Stefani 1, 37100, Verona, Italy

    S. Montemezzi

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  1. F. Fornasa
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  2. L. Pinali
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  3. A. Gasparini
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  4. E. Toniolli
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Correspondence to F. Fornasa.

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Fornasa, F., Pinali, L., Gasparini, A. et al. Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation. Radiol med 116, 264–275 (2011). https://doi.org/10.1007/s11547-010-0602-4

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  • DOI: https://doi.org/10.1007/s11547-010-0602-4

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