Akın Yasin, Uğurlu M Ümit, Kaya Handan, Arıbal Erkin
Department of Radiology, Marmara University School of Medicine, İstanbul, Turkey.
Department of General Surgery, Marmara University School of Medicine, İstanbul, Turkey.
J Breast Health. 2016 Jul 1;12(3):123-132. doi: 10.5152/tjbh.2016.2897. eCollection 2016 Jul.
The aim of this study was to evaluate the effect of the apparent diffusion coefficient (ADC) and diffusion-weighted imaging in differentiating benign from malignant breast lesions, histopathologic subtypes of breast tumors, and to find a correlation with prognostic factors using 3T MR.
A total of 165 patients aged between 16 and 78 years with 181 histopathologically-verifed breast lesions were enrolled in this study. A 3T MR system and bilateral phased array breast coil was used. Diffusion-weighted imaging was performed with spin echo "echo planar" with "b" values: 50, 400, and 800 seconds/mm. ADC values were calculated for normal fibroglandular tissue and breast lesions. ADC values of independent groups were compared using Student's t-test. ROC analysis was used to find a threshold ADC value in the differentiation of lesions.
The mean ADC values were 1.35±0.16 × 10 mm/s for normal fibroglandular tissue, 1.41±0.24 × 10 mm/s for benign breast lesions and 0.83±0.19 × 10 mm/s for malignant breast lesions. The AUC with ROC analysis was 0.945 and the threshold for ADC was 1.08 × 10 mm/s with a sensitivity and specificity of 92% and 92%, respectively. The threshold value for ADC ratio was 0.9 with 96% sensitivity and 89% specificity. The mean ADC of malignant breast lesions was statistically lower for benign lesions (p<0.01). We found no correlation between the mean ADC values and ER-PR receptor, Her2, and Ki-67 values.
Diffusion-weighted imaging has high diagnostic value with high sensitivity and specificity in differentiating malignant and benign breast lesions.
本研究旨在评估表观扩散系数（ADC）和扩散加权成像在鉴别乳腺良恶性病变、乳腺肿瘤组织病理学亚型方面的作用，并利用3T磁共振成像（MR）寻找其与预后因素的相关性。
本研究共纳入165例年龄在16至78岁之间、有181个经组织病理学证实的乳腺病变的患者。使用3T MR系统和双侧相控阵乳腺线圈。采用自旋回波“回波平面”序列进行扩散加权成像，“b”值分别为50、400和800秒/平方毫米。计算正常纤维腺组织和乳腺病变的ADC值。采用学生t检验比较独立组的ADC值。利用ROC分析确定病变鉴别中的ADC阈值。
正常纤维腺组织的平均ADC值为（1.35±0.16）×10⁻³毫米²/秒，乳腺良性病变为（1.41±0.24）×10⁻³毫米²/秒，乳腺恶性病变为（0.83±0.19）×10⁻³毫米²/秒。ROC分析的AUC为0.945，ADC阈值为1.08×10⁻³毫米²/秒，敏感性和特异性分别为92%和92%。ADC比值的阈值为0.9，敏感性为96%，特异性为89%。乳腺恶性病变的平均ADC值在统计学上低于良性病变（p<0.01）。我们发现平均ADC值与雌激素受体-孕激素受体（ER-PR）、人表皮生长因子受体2（Her2）和Ki-67值之间无相关性。
扩散加权成像在鉴别乳腺良恶性病变方面具有高敏感性和特异性，具有较高的诊断价值。
