HER2-positive mucinous cystadenocarcinoma of the breast coexisting with invasive lobular carcinoma: A case report and review of the literature.

Primary mucinous cystadenocarcinoma (MCA) of the breast is a rare variant of breast carcinoma. A 68-year-old female patient presented to the general surgery clinic with pain and swelling in the right breast. A mass was detected in the upper outer quadrant, and a fine-needle aspiration biopsy was performed. The May-Grünwald Giemsa stained slides showed aggregates of mucin-rich pleomorphic cells with large nuclei in a mucinous background containing discohesive single cells. The Papanicolaou stain revealed a papillary structure composed of malignant epithelial cells in a necrotic background. A modified radical mastectomy was performed, and upon gross examination, two tumors were discovered in the central and upper outer quadrants. The first tumor, located centrally, was identified as invasive lobular breast carcinoma. The second tumor was an MCA with cytokeratin 7(+) and cytokeratin 20(-), and was determined to be the primary MCA of the breast based on clinical and radiological information. Immunohistochemistry revealed that the tumor cells were negative for estrogen receptor and progesterone receptor, and HER2 was 2+. Fluorescence in situ hybridization analysis detected HER2 gene amplification. During the 72-month follow-up, there were no findings compatible with recurrence or new metastasis. Although primary MCA is rare, it causes differential diagnosis problems and has different biological behaviors.

Frequency and Related Risk Factors of Refeeding Hypophosphatemia in Patients with Liver Cirrhosis: A Pilot Study.

BACKGROUND AND AIM: Refeeding hypophosphatemia (RH) is associated with poor clinical outcomes and mortality. The presence of RH in patients with liver cirrhosis remains unclear. This study aims to determine the frequency of RH related to nutritional status and disease severity in liver cirrhosis. METHODS: This study was prospectively conducted in a-single center gastroenterology clinic. Malnutrition was identified by Subjective Global Assessment (SGA). The disease severity was defined using Child score and MELD score. Serum phosphate levels <2.0 mg/dl are defined as hypophosphatemia. RESULTS: Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in 4 patients on day 4 during study follow up. The sharpest decline of serum phosphate levels was on day 4 (median: 2.3mg/dL). The Child score and MELD score were not significantly different between RH and Non-RH groups (p>0.05). The rate of malnutrition according to SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher presence of RH than patients receiving only oral or enteral tube feding (p<0.05). CONCLUSIONS: RH developed in » of the study participants. This study also showed that artificial feeding carries a significant risk in terms of RH. Malnourished patients with liver cirrhosis receiving parenteral nutrition, closely monitored regarding high risk of RH.

Anthocyanin-rich black carrot (Daucus carota ssp. sativus var. atrorubens Alef.) and red cabbage (Brassica oleracea) extracts incorporated biosensor for colorimetric detection of Helicobacter pylori with color image processing.

In this work, we developed novel colorimetric biosensors consisting of anthocyanin-rich either black carrot (Daucus carota ssp. sativus var. atrorubens Alef.) or red cabbage (Brassica oleracea) extracts for rapid, sensitive, and economic detection of Helicobacter pylori (H. pylori). We comparatively prepared two test solutions as biosensors including anthocyanin-rich black carrot extract (Anth@BCE) and red cabbage extract (Anth@RCE), both of which fixed to pH 2.5 and investigated their colorimetric responses based on electronic structure and electron density of anthocyanins. We successfully used anthocyanin-rich BCE and RCE as natural pH indicators in detection of H. pylori and introduced their advantages like non-toxicity, easy accessibility, and high stability compared to synthetic indicators. The BCE and RCE tests gave the best color change in the presence of 103 CFU/mL (at 60 min) and 104 CFU/mL (at 75 min) H. pylori suspensions prepared in an artificial gastric fluid. The limit of detection was down to 10 CFU/mL for RCE and BCE tests by increasing incubation time (≥ 5 h). We further made an additional study that color differences in the colorimetric responses observed by naked eyes were supported by digital image processing with RGB (Red Green Blue) and Delta-E (ΔE) analysis. It is confirmed that results evaluated by naked eyes and digital image processing are well consistent with each other. These findings proposed that these colorimetric tests can be implemented to pH dependent detection of various microorganisms and can be effectively transferred from laboratory work to clinics in the near future.

Outcomes of high-risk breast lesions diagnosed using image-guided core needle biopsy: results from a multicenter retrospective study.

PURPOSE: The clinical management of high-risk lesions using image-guided biopsy is challenging. This study aimed to evaluate the rates at which such lesions were upgraded to malignancy and identify possible predictive factors for upgrading high-risk lesions. METHODS: This retrospective multicenter analysis included 1.343 patients diagnosed with high-risk lesions using an image-guided core needle or vacuum-assisted biopsy (VAB). Only patients managed using an excisional biopsy or with at least one year of documented radiological follow-up were included. For each, the Breast Imaging Reporting and Data System (BI-RADS) category, number of samples, needle thickness, and lesion size were correlated with malignancy upgrade rates in different histologic subtypes. Pearson's chi-squared test, the Fisher-Freeman-Halton test, and Fisher's exact test were used for the statistical analyses. RESULTS: The overall upgrade rate was 20.6%, with the highest rates in the subtypes of intraductal papilloma (IP) with atypia (44.7%; 55/123), followed by atypical ductal hyperplasia (ADH) (38.4%; 144/375), lobular neoplasia (LN) (12.7%; 7/55), papilloma without atypia (9.4%; 58/611), flat epithelial atypia (FEA) (8.7%; 10/114), and radial scars (RSs) (4.6%; 3/65). There was a significant relationship between the upgrade rate and BI-RADS category, number of samples, and lesion size Lesion size was the most predictive factor for an upgrade in all subtypes. CONCLUSION: ADH and atypical IP showed considerable upgrade rates to malignancy, requiring surgical excision. The LN, IP without atypia, pure FEA, and RS subtypes showed lower malignancy rates when the BI-RADS category was lower and in smaller lesions that had been adequately sampled using VAB. After being discussed in a multidisciplinary meeting, these cases could be managed with follow-up instead of excision.

Healthcare-Related HCV Genotype 4d Infections in Kayseri, Turkey.

BACKGROUND: The frequency of genotype 4 hepatitis C virus infection is significantly higher in a city compared to other provinces in Turkey. In this study, we aimed to investigate the epidemiology and risk factors of hepatitis C virus genotype 4 infection in Kayseri province of Turkey. METHODS: A case-control study was conducted with 61 hepatitis C virus genotype 4-infected patients and 71 controls. A questionnaire was administered to the patients and controls, asking for information about the risk factors of hepatitis C virus transmission. Core/ E1 and NS5B regions of hepatitis C virus genome were amplified and sequenced by Sanger method. Phylogenetic analysis and molecular clock analysis were performed. The risk was determined by calculating the odds ratio and 95% CI. Logistic regression analysis was performed to determine the effect of risk factors by controlling for confounding variables. RESULTS: Kayseri isolates were closely related to type 4d sequences but formed a separate cluster. According to the molecular clock analysis, hepatitis C virus genotype 4d entered Kayseri province probably between 1941 and 1988. Blood transfusion and surgical intervention were found to be significant risk factors for the infection. CONCLUSION: Epidemiological data showed that hepatitis C virus genotype 4d infections are significantly associated with unsafe medical procedures.

Clinicopathological analysis of invasive cribriform carcinoma of the breast, with review of the literature.

Invasive cribriform carcinoma (ICC) is a rare type of a primary breast carcinoma. It is subdivided into two groups as pure and mixed types. There are limited studies comparing the pure and mixed ICC at present. We aim to investigate the clinicopathological, radiological, prognostic features, and survival outcomes of two types with reviewing the published literature. 16 pure ICC and 26 mixed ICC cases were evaluated. The population consisted of 41 female and 1 male patients. The only male patient was a pure ICC case. The median age was for pure and mixed type, 46.5 and 54 years, respectively. All ICCs were ER positive. All ICCs except one mixed ICC, were positive for PR. Only one mixed ICC was accepted HER2 positive (3+). Pure ICCs showed more favorable features than mixed ICCs such as lesser axillary lymph node involvement, lower grade, and proliferation index. Twenty-five patients had one of the following imaging methods; ultrasonography (US), mammography (MG), and magnetic resonance imaging (MRI). Irregular shape, hypoechogenicity, and spiculated margins were the most common US findings. Similarly, irregular shape+spiculated margin is the most common MG findings. The median follow-up time for pure and mixed ICC was 88 and 56.5 months, respectively. One mixed ICC case developed bone metastasis. One death occurred in each group. Reasons of death were unknown. The 5-year OS for both ICC groups was 100%. 10-year OS for pure and mixed ICCs was 100% and 90%, respectively. 5-year DFS was 100% for pure ICC, and 94% for mixed ICC.

Novel Anthocyanin-Based Colorimetric Assay for the Rapid, Sensitive, and Quantitative Detection of Helicobacter pylori.

Several different diagnostic tests have been reported for rapid, sensitive, and economical detection of bacterial pathogens, but most lack widespread and practical use in the clinic. In this study, we used anthocyanins from red cabbage (Brassica oleracea) as a natural pH indicator and, for the first time, incorporated this agent into a simple, rapid, and economical colorimetric strategy for the detection of Helicobacter pylori (H. pylori) (RCE@test). We prepared two sets of RCE@test solutions (test 1 is purple, and test 2 is blue) in different forms, including liquid, adsorbed filter paper, and agar, and investigated the performance of each RCE@test as a function of the test volume, H. pylori concentration, and reaction time. To elucidate the effect of the pathophysiological environment on these RCE@tests, H. pylori in an artificial gastric fluid was also detected. The 10 and 1 CFU/mL H. pylori suspensions were detected in 15 min and 3 h, respectively, and the limit of detection was determined down to 1 CFU/mL. We experimentally demonstrated the advantages of the RCE@test for detection of H. pylori by comparing it to a commercially available rapid urease test, the "CLO test (Campylobacter-like organism test)". In addition to colorimetric detection by the naked eyes, RGB (Red Green Blue) and Delta-E analysis in image-processing software was run to quantitatively monitor changes of color in the RCE@test using a smartphone application. Finally, we propose that this test provides simple, effective, rapid, and inexpensive detection and that it can be easily implemented for clinical use.

Exogenous pulmonary surfactant: A review focused on adjunctive therapy for severe acute respiratory syndrome coronavirus 2 including SP-A and SP-D as added clinical marker.

Type I and type II pneumocytes are two forms of epithelial cells found lining the alveoli in the lungs. Type II pneumocytes exclusively secrete 'pulmonary surfactants,' a lipoprotein complex made up of 90% lipids (mainly phospholipids) and 10% surfactant proteins (SP-A, SP-B, SP-C, and SP-D). Respiratory diseases such as influenza, severe acute respiratory syndrome coronavirus infection, and severe acute respiratory syndrome coronavirus 2 infection are reported to preferentially attack type II pneumocytes of the lungs. After viral invasion, consequent viral propagation and destruction of type II pneumocytes causes altered surfactant production, resulting in dyspnea and acute respiratory distress syndrome in patients with coronavirus disease 2019. Exogenous animal-derived or synthetic pulmonary surfactant therapy has already shown immense success in the treatment of neonatal respiratory distress syndrome and has the potential to contribute efficiently toward repair of damaged alveoli and preventing severe acute respiratory syndrome coronavirus 2-associated respiratory failure. Furthermore, early detection of surfactant collectins (SP-A and SP-D) in the circulatory system can be a significant clinical marker for disease prognosis in the near future.

The role of rare breast cancers in the false negative strain elastography results.

PURPOSE: Elastography was primarily used as an adjunctive method along with ultrasonography in differentiation between benign from malignant lesions. Occasionally, overlaps can occur which are caused by some rare invasive breast cancers. Our aim is to analyze the role of rare breast cancers in false negative strain elastography results and to assess the relation among false negative results and tumor size, lesion distance to skin, and tumor grade. METHODS: Patients with BI-RADS 5 category underwent strain elastography and core biopsy. All those with confirmed invasive breast cancer were included. For each rare breast cancer, four usual invasive breast cancer cases were taken as a control group. The cut-off value of strain ratio was considered as 2.3. The true positive and the false negative groups were compared in terms of histological type (rare carcinomas and the others) and the other parameters. Pearson Chi-square and Fisher's exact test were used for statistical analyses. P values < 0.05 were considered statistically significant. RESULTS: One hundred-thirteen patients were defined as true positive (70.6%), and 47 patients were defined as false negative (29.4%). Strain ratio values of the rare breast cancers were significantly lower than those of the other breast cancers (p = 0.012). There was no statistically significant difference between the groups with respect to tumor size, distance to skin, and tumor grade (p > 0.05). CONCLUSION: The rare breast cancers are an important cause of false negativity in elastographic evaluation of invasive breast cancers. The results should be interpreted in combination with grayscale US findings.

Interacting Factors of Strain Ratio Values in Fibroadenomas and the Contribution of Color Scale.

BACKGROUND: The purpose of this retrospective study is to investigate the association of qualitative and semiquantitative strain elastography (SE) features with factors such as lesion size, skin-to-lesion distance, and patient's age in fibroadenomas and to discuss false-positive results. METHODS: A total of 120 lesions that were performed SE with histopathologically confirmed fibroadenoma were included in the study. All images were reviewed from the archiving system with a consensus of two radiologists. Tsukuba elasticity score was used for color scoring (from 1 to 5). Lesions with strain ratio (SR) ≥2.27 and color scale score of 4 or 5 were considered as false positive. The patients were divided into two groups according to the age: <50 and ≥50 years old. Regard of the size, lesions were divided into two groups: <15 mm and ≥15 mm. The distances of the lesions to the skin were also divided into two groups: <5 mm and ≥5 mm. Statistical analysis to identify associations between these groups and SR was carried out with Pearson Chi-square test and Fisher's exact test. The false-positive rates were calculated. RESULTS: There was no statistically significant difference between patients' age, lesion size, skin-to-lesion distance, and SR values. The false-positive rate was 21.66% for SR, while it was 3.33% for color scale. CONCLUSION: SR values of the fibroadenomas were not affected by factors such as age, lesion size, and depth. In addition, false-positive rates significantly decrease when color scale scores are evaluated for fibroadenomas.

Tumor size estimation of the breast cancer molecular subtypes using imaging techniques.

BACKGROUND AND AIM: In medical practice the classification of breast cancer is most commonly based on the molecular subtypes, in order to predict the disease prognosis, avoid over-treatment, and provide individualized cancer management. Tumor size is a major determiner of treatment planning, acting on the decision-making process, whether to perform breast surgery or administer neoadjuvant chemotherapy. Imaging methods play a key role in determining the tumor size in breast cancers at the time of the diagnosis.We aimed to compare the radiologically determined tumor sizes with the corresponding pathologically determined tumor sizes of breast cancer at the time of the diagnosis, in correlation with the molecular subtypes. METHODS: Ninety-one patients with primary invasive breast cancer were evaluated. The main molecular subtypes were luminal A, luminal B, HER-2 positive, and triple-negative. The Bland-Altman plot was used for presenting the limits of agreement between the radiologically and the pathologically determined tumor sizes by the molecular subtypes. RESULTS: A significantly proportional underestimation was found for the luminal A subtype, especially for large tumors. The p-values for the magnetic resonance imaging, mammography, and ultrasonography were 0.020, 0.030, and <0.001, respectively. No statistically significant differences were observed among the radiologic modalities in determining the tumor size in the remaining molecular subtypes (p>0.05). CONCLUSION: The radiologically determined tumor size was significantly smaller than the pathologically determined tumor size in the luminal A subtype of breast cancers when measured with all three imaging modalities. The differences were more prominent with ultrasonography and mammography. The underestimation rate increases as the tumor gets larger.

Migraine or idiopathic intracranial hypertension: Magnetic resonance venography and magnetic resonance imaging findings.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a disease characterised by increased cerebral pressure without a mass or hydrocephalus. We aimed to differentiate migraine and IIH patients based on imaging findings. RESULTS: Patients with IIH (n = 32), migraine patients (n = 34) and control subjects (n = 33) were evaluated. Routine magnetic resonance imaging, contrast-enhanced 3D magnetic resonance venography and/or T1-weighted 3D gradient-recalled echo were taken with a 1.5 T magnetic resonance scanner. Optic-nerve sheath distention, flattened posterior globe and the height of the pituitary gland were evaluated in the three groups. Transverse sinuses (TS) were evaluated with respect to score of attenuation/stenosis and distribution. Pearson chi-square, Fisher's exact test and chi-square trend statistical analyses were used for comparisons between the groups. A p-value of <0.05 was considered statistically significant. Decreased pituitary gland height, optic-nerve sheath distention and flattened posterior globe were found to be statistically significant (p < 0.001) in IIH patients. Bilateral TS stenosis was also more common in IIH patients than in the control group and migraine group (p = 0.02). CONCLUSION: Decreased pituitary gland height, optic-nerve sheath distention, flattened posterior globe, bilateral stenosis and discontinuity in TS are significant findings in differentiating IIH cases from healthy individuals and migraine patients. Bilateral TS stenosis may be the cause rather than the result of increased intracranial pressure. The increase in intracranial pressure, which is considered to be responsible for the pathophysiology of IIH, is not involved in the pathophysiology of migraine.

Histopathological and Tumor Characteristics Associated with False Negative Axillary Ultrasonography Results in Breast Cancer.

AIMS: As the false-negative rates of axillary ultrasonography (AUS) (21%-48%) are not optimal, the demand for axillary surgery remains even if AUS is negative. The aim of this study is to determine the histopathological and tumor characteristics associated with false-negative AUS results. MATERIALS AND METHODS: Patients with normal AUS were divided into two groups as true-negative and false-negative according to the histopathology results of axillary lymph nodes. Two groups were compared in terms of age, histological grade of the primary tumor, histological size of the primary tumor, histological type, lymphovascular invasion (LVI), and ultrasonography BI-RADS classification of the primary tumor. The number of metastatic lymph nodes, size of the largest metastatic lymph node and the number of micrometastatic lymph nodes were also noted in the false-negative group. RESULTS: There were 152 patients with normal preoperative AUS in the study group. The false-negative AUS rate was 20.4%. The incidence of invasive lobular carcinoma (ILC) and the mean tumor size was significantly greater in the false-negative group. Micrometastasis was present in 3 patients (3/31, 9.6%), the mean of the largest metastatic lymph nodes was 12.5 mm, the mean total number of malignant lymph nodes was 1.9 in the false-negative group. In 25/31 (80.6%) of the patients, there were less than or equal to 2 metastatic lymph nodes. The presence of LVI was higher in the false-negative group. There was no significant difference between the groups in terms of the other parameters. CONCLUSION: Before stating that the axilla is normal on ultrasonography, a careful evaluation should be made in patients with a mass >2 cm in size and/ or ILC diagnosis.

Lumbosacral transitional vertebra in the young men population with low back pain: anatomical considerations and degenerations (transitional vertebra types in the young men population with low back pain).

INTRODUCTION: To evaluate the prevalence of subtypes of congenital lumbosacral transition vertebra (LSTV) in young male populations with low back pain (LBP) and their relationship to lumbar disc and facet degeneration. MATERIALS AND METHODS: 1875 patients (male, aged; 18-40 years) with LBP were investigated retrospectively. Standard lumbar MRI protocol of sagittal, and axial T1 weighted images (WI) and T2 WI and coronal short tau inversion recovery (STIR) T2 WI were obtained. Castellvi classification of LSTV were used for subtyping. The level and above the level of LSTV were evaluated for the lumbar disc space and facet degeneration based on grading methods which compares subtype groups with each other. RESULTS: Prevalence of LSTV was 32% (600 of 1875). The most frequent LSTV types were type I (dysplastic enlarged transverse process; 66.5%) and type II (pseudoarticulation; 21.8%). Eight percent of the patients were type III (fusion) and 3.6% patients type IV (one transverse process fused and one with pseudoarticulation). The most commonly detected LSTV types were type I + II (88%) and all bilateral LSTV types were seen much more than unilateral types (bilateral versus unilateral 63.2%, 33.2%). The LSTV type I highly correlated with the disc degeneration and facet arthrosis. But the groups with higher grade of disc degeneration were type IV and III. CONCLUSION: In young male patients with LBP, LSTV was found to be high in frequency and mostly occurred to be subtype I. LSTV type I and associated disk and facet degeneration were found to be remarkable in this group. Coronal T2 STIR images are useful in showing lumbosacral region anomalies and variants, and should be included in the routine lumbar MRI protocol.

Treatment choice in metaplastic breast cancer: A report of 5 cases.

Metaplastic breast carcinoma (MBC) is a general term defining a heterogeneous group that includes biphasic lesions, with both malignant epithelial and mesenchymal tissue components. Although its clinical findings are similar to those present in invasive ductal carcinoma, it rarely presents with the findings of inflammatory breast cancer. It is generally seen in the fifth decade. MBC spreads via lymph and blood circulation. Most common distant metastasis areas include lungs and the bone. Although the treatment generally relies on the same principles applied in invasive ductal carcinoma, a more aggressive treatment should be employed in at-risk groups due to higher rates of local recurrence. In this study, we aimed to discuss clinicopathological features and treatment approach in 5 women with MBC.

Best prognostic factor of neuroendocrine tumors: Grade or Stage? A multidisciplinary single-center study.

BACKGROUND/AIMS: Currently, there is no definite consensus about the prognostic factors of neuroendocrine tumors (NETs). We evaluate epidemiology, survival and especially prognostic factors in NETs. MATERIALS AND METHODS: Patients who had a NET and were diagnosed between 2000 and 2014 at a tertiary care center were included. Demographic data, tumor characteristics and survival rates were evaluated, retrospectively. RESULTS: Two-hundred and thirty-three patients (123 male, 110 female; median age, 55 years [16-92 years]) took part in the study. Primary NET sites were the lung (n=56), stomach (n=50), pancreas (n=39), colorectal (n=21), small intestine (n=19), and appendix (n=19). According to the NET classification by the WHO in 2010, 60% (n=140) of patients were grade-1, 15% (n=35) were grade-2, and 25% (n=58) were grade-3. According to TNM staging, 88 patients (37.8%) were stage I, 30 patients (12.8%) were stage II, 22 patients (9.5%) were stage III, and 93 patients (39.9%) were stage IV. Univariate analysis revealed significant associations between gender, age, grade, lymph node metastasis, distant metastasis, stage, and the number of organs impacted by metastases and overall survival. However, with multivariate analysis only age greater than 55 years, advancing grade, and inoperable tumors were significantly associated with shortened survival. Five-year survival was 81% in grade-1, 34% in grade-2, and 9% in grade-3 NETs. CONCLUSION: This study is the most comprehensive study in Turkey that has evaluated NETs using a multidisciplinary approach. Also, we suggest that age, operability and especially grade rather than stage are the most important prognostic factors in NETs.

Plasma glutamine and cystine are decreased and negatively correlated with endomysial antibody in children with celiac disease.

BACKGROUND AND OBJECTIVES: Glutamine is a nonessential amino acid which improves intestinal mucosal regeneration and absorption. Glutathione is a vital molecule for antioxidant reactions and is synthesized from cystine. The first aim of the study is to measure the plasma glutamine and cystine in children with celiac disease (CD) and compare them with controls. The second aim of this study is to investigate whether these amino acids are correlated with endomysial antibody (EMA) or not. METHODS AND STUDY DESIGN: Fifty children with CD were compared to 50 healthy, age, and sex matched normal children as control. Plasma glutamine and cystine levels of the children were measured by using tandem mass spectrometry. RESULTS: Plasma glutamine (808 vs 870 µmol/L) and cystine (19 vs 48.5 µmol/L) were significantly lower in the celiac group than the controls (p<0.05). The levels of plasma glutamine (797 vs 928 µmol/L, n=42) and cystine (18 vs 31.5 µmol/L, n=8) were lower (p<0.05) in the EMA-positive than the EMA-negative celiac patients. We could not find any statistically significance between EMA-negative celiac patients and controls for the plasma glutamine (928 vs 870 µmol/L) and cystine (31.5 vs 48.5 µmol/L) (p>0.05). Serum EMA was negatively correlated with plasma cystine (r=-0,321, p=0.023), glutamine (r=-0.413, p=0.003). CONCLUSIONS: Our study indicated that plasma glutamine and cystine were significantly lower in the celiac children than the controls. Also, these amino acids were negatively correlated with EMA.

Value of Apparent Diffusion Coefficient Values in Differentiating Malignant and Benign Breast Lesions.

BACKGROUND: Magnetic resonance imaging (MRI) has become a diagnostic and problem solving method for the breast examinations in addition to conventional breast examination methods. Diffusion-weighted imaging (DWI) adds valuable information to conventional MRI. AIMS: Our aim was to show the impact of apparent diffusion coefficient (ADC) values acquired with DWI to differentiate benign and malignant breast lesions. STUDY DESIGN: Diagnostic accuracy study. METHODS: Forty-six women with 58 breast masses (35 malignant, 23 benign) were examined on a 1.5 T clinical MRI scanner. The morphologic characteristics of the lesions on conventional MRI sequences and contrast uptake pattern were assessed. ADC values of both lesions and normal breast parenchyma were measured. The ADC values obtained were statistically compared with the histopathologic results using Paired Samples t-Test. RESULTS: Multiple lesions were detected in 12 (26%) of the patients, while only one lesion was detected in 34 (74%). Overall, 35 lesions out of 58 were histopathologically proven to be malignant. In the dynamic contrast-enhanced series, 5 of the malignant lesions were type 1, while 8 benign lesions revealed either type 2 or 3 time signal intensity curves (85% sensitivity, 56% spesifity). Mean ADC values were significantly different in malignant vs. benign lesions. (1.04±0.29×10(-3) cm(2)/sec vs. 1.61±0.50×10(-3) cm(2)/sec for the malignant and benign lesions, respectively, p=0.03). A cut-off value of 1.30×10(-3) mm(2)/sec for ADC detected with receiver operating characteristic analysis yielded 89.1% sensitivity and 100% specificity for the differentiation between benign and malignant lesions. CONCLUSION: ADC values improve the diagnostic accuracy of solid breast lesions when evaluated with the conventional MRI sequences. Therefore, DWI should be incorporated to routine breast MRI protocol.