Department of Radiology, Ospedale Scaligero Veronese, Via Fontanelle, 1, 37047, S. Bonifacio, Verona, Italy.
Radiol Med. 2011 Mar;116(2):264-75. doi: 10.1007/s11547-010-0602-4. Epub 2010 Oct 6.
This study assessed the usefulness of magnetic resonance diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions.
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.
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%).
DWI is a reliable tool for characterising focal breast lesions.
本研究评估磁共振扩散加权成像（DWI）在鉴别良恶性乳腺病变中的作用。
对 78 名女性进行了钆增强磁共振成像（MRI）和 DWI 检查，并测定表观扩散系数（ADC）。每位女性均有至少 7mm 直径的局灶性乳腺病变，通过细胞学或组织学进行研究。
细胞学诊断 29 例，组织学诊断 49 例（11 例经皮活检，38 例手术标本）。43 例为良性病变（13 例纤维囊性疾病，8 例纤维腺瘤，7 例腺病，5 例正常乳腺组织，4 例炎症性病变，3 例乳腺内淋巴结，2 例硬化性弹性纤维瘤，1 例脂肪坏死），35 例为恶性病变（30 例浸润性导管癌，2 例浸润性小叶癌，1 例导管原位癌，1 例癌性乳腺炎，1 例神经内分泌癌转移）。良性病变的平均 ADC 值为 1.677±0.151，恶性病变的平均 ADC 值为 1.298±0.129（p<0.001）。以 ADC 截断值为 1.48 时，DWI 的灵敏度为 88.6%（78.1%-99.1%），特异性为 95.3%（88.9%-100%），真阳性 31 例，假阴性 4 例（3 例浸润性导管癌，1 例癌性乳腺炎），真阴性 41 例，假阳性 2 例（1 例脂肪坏死，1 例纤维腺瘤）。以截断值设定为 1.52 时，DWI 的灵敏度（35 例真阳性，无假阴性）为 100%，特异性为 86%（75.7%-96.3%），真阴性 37 例，假阳性 6 例（与截断值设定为 1.48 相比，另外 2 例纤维腺瘤和 2 例纤维囊性疾病）。考虑到两个截断值，DWI 的总体准确性为 92.3%（78 例中有 72 例正确评估）（86.4%-98.2%）。
DWI 是一种可靠的局灶性乳腺病变特征描述工具。
