ABSTRACT
Objective: To determine the diagnostic accuracy of Diffusion Weighted Magnetic Resonance Imaging/Apparent and Diffusion Coefficient [DWI/ADC sequences] in malignant breast lesions taking histopathology as gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Combined Military Hospitals Quetta and Peshawar, from Sep 2013 to Mar 2015 and Armed Forces Institute of Radiology and Imaging Rawalpindi, from Apr 2015 to Dec 2015
Material and Methods: After informed consent, patients scheduled for biopsy of a suspicious breast lesion on sonomammography and/or mammography [BIRADS IV and V], fulfilling the inclusion criteria were evaluated with breast MRI including Diffusion Weighted Imaging [DWI] sequence using b-values of 0 and 750 mm[2]/sec. Apparent Diffusion Coefficient [ADC] values for the breast lesions were also calculated. MRI findings were correlated with histopathological results
Results: A total of 299 cases were included in the study. Mean age of the study population was 45.73 years [SD +/- 15.02] with a range of 18 to 89 years. On histopathology 77.9% [n=233] lesions turned to be malignant and 22.1% [n=66] were benign. On DWI 73% [n=219] lesions showed restricted diffusion and were labeled malignant while 27% [n=80] lesions showed facilitated diffusion and were considered benign. The mean apparent diffusion coefficient value of the malignant breast lesions was significantly lower than that of the benign breast lesions [p-value<0.001]. The calculated sensitivity, specificity, positive predictive value and negative predictive values of DWI/ADC mapping in differentiating between malignant and benign lesions were 92.2%, 93.9%, 98.1% and 77.5% respectively. The diagnostic accuracy was found to be 92.6%
Conclusion: DWI is a non-invasive diagnostic modality for diagnosing malignant breast lesions. It can be used to reduce the number of unnecessary biopsies and it may help in reaching a definite diagnosis in cases where a suspicious breast lesion cannot be biopsied because of its small size or unsuitable location