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Nonmalignant breast lesions: ADCs of benign and high-risk subtypes assessed as false-positive at dynamic enhanced MR imaging.

Abstract：

PURPOSE:To evaluate the diffusion-weighted (DW) imaging characteristics of nonmalignant lesion subtypes assessed as false-positive findings at conventional breast magnetic resonance (MR) imaging. MATERIALS AND METHODS:This HIPAA-compliant retrospective study had institutional review board approval, and the need for informed patient consent was waived. Lesions assessed as Breast Imaging Reporting and Data System category 4 or 5 at clinical dynamic contrast material-enhanced MR imaging that subsequently proved nonmalignant at biopsy were retrospectively reviewed. One hundred seventy-five nonmalignant breast lesions in 165 women were evaluated. Apparent diffusion coefficients (ADCs) from DW imaging (b = 0, 600 sec/mm(2)) were calculated for each lesion and were compared between subtypes and with an ADC threshold of 1.81 × 10(-3) mm(2)/sec (determined in a prior study to achieve 100% sensitivity). RESULTS:Eighty-one (46%) lesions exhibited ADCs greater than the predetermined threshold. The most prevalent lesion subtypes with mean ADCs above the threshold were fibroadenoma ([1.94 ± 0.38 {standard deviation}] × 10(-3) mm(2)/sec; n = 30), focal fibrosis ([1.84 ± 0.48] × 10(-3) mm(2)/sec; n = 19), normal tissue ([1.81 ± 0.47] × 10(-3) mm(2)/sec; n = 13), apocrine metaplasia ([2.01 ± 0.38] × 10(-3) mm(2)/sec; n = 13), usual ductal hyperplasia ([1.83 ± 0.49] × 10(-3) mm(2)/sec; n = 12), and inflammation ([1.95 ± 0.46] × 10(-3) mm(2)/sec; n = 10). Atypical ductal hyperplasia ([1.48 ± 0.36] × 10(-3) mm(2)/sec; n = 23) was the most common lesion subtype with ADC below the threshold. Lymph nodes exhibited the lowest mean ADC of all nonmalignant lesions ([1.28 ± 0.23] × 10(-3) mm(2)/sec; n = 4). High-risk lesions (atypical ductal hyperplasia and lobular neoplasia) showed significantly lower ADCs than other benign lesions (P < .0001) and were the most common lesions with ADCs below the threshold. CONCLUSION:Assessing ADC along with dynamic contrast-enhanced MR imaging features may decrease the number of avoidable false-positive findings at breast MR imaging and reduce the number of preventable biopsies. The ability of DW imaging to help differentiate high-risk lesions requiring additional work-up from other nonmalignant subtypes may further improve patient care. SUPPLEMENTAL MATERIAL:http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112672/-/DC1.

journal_name

Radiology

journal_title

Radiology

authors

Parsian S,Rahbar H,Allison KH,Demartini WB,Olson ML,Lehman CD,Partridge SC

doi

10.1148/radiol.12112672

subject

Has Abstract

pub_date

2012-12-01 00:00:00

pages

696-706

issue

eissn

0033-8419

issn

1527-1315

pii

radiol.12112672

journal_volume

265

pub_type

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Nonmalignant breast lesions: ADCs of benign and high-risk subtypes assessed as false-positive at dynamic enhanced MR imaging.