Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6021-6031
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6021
Value of magnetic resonance diffusion combined with perfusion imaging techniques for diagnosing potentially malignant breast lesions
Hui Zhang, Xin-Yi Zhang, Yong Wang
Hui Zhang, Department of Radiology, Hebei General Hospital, Shijiazhuang 050000, Hebei Province, China
Xin-Yi Zhang, Yong Wang, Department of Radiology, the First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Zhang H and Wang Y designed the experiment. Zhang XY implemented the experiment; Zhang H and Wang Y drafted the manuscript; Wang Y was responsible for the paper.
Institutional review board statement: The study was reviewed and approved by the First Hospital of Hebei Medical University Institutional Review Board, No. 20210907.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at wy80868@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Wang, MHSc, Department of Radiology, the First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang 050000, Hebei Province, China. wy80868@163.com
Received: December 7, 2021
Peer-review started: December 7, 2021
First decision: January 25, 2022
Revised: March 23, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 26, 2022
Processing time: 191 Days and 12.8 Hours
Abstract
BACKGROUND

Lesions of breast imaging reporting and data system (BI-RADS) 4 at mammography vary from benign to malignant, leading to difficulties for clinicians to distinguish between them. The specificity of magnetic resonance imaging (MRI) in detecting breast is relatively low, leading to many false-positive results and high rates of re-examination or biopsy. Diffusion-weighted imaging (DWI), combined with perfusion-weighted imaging (PWI), might help to distinguish between benign and malignant BI-RADS 4 breast lesions at mammography.

AIM

To evaluate the value of DWI and PWI in diagnosing BI-RADS 4 breast lesions.

METHODS

This is a retrospective study which included patients who underwent breast MRI between May 2017 and May 2019 in the hospital. The lesions were divided into benign and malignant groups according to the classification of histopathological results. The diagnostic efficacy of DWI and PWI were analyzed respectively and combinedly. The 95 lesions were divided according to histopathological diagnosis, with 46 benign and 49 malignant. The main statistical methods used included the Student t-test, the Mann-Whitney U-test, the chi-square test or Fisher’s exact test.

RESULTS

The mean apparent diffusion coefficient (ADC) values in the parenchyma and lesion area of the normal mammary gland were 1.82 ± 0.22 × 10-3 mm2/s and 1.24 ± 0.16 × 10-3 mm2/s, respectively (P = 0.021). The mean ADC value of the malignant group was 1.09 ± 0.23 × 10-3 mm2/s, which was lower than that of the benign group (1.42 ± 0.68 × 10-3 mm2/s) (P = 0.016). The volume transfer constant (Ktrans) and rate constant (Kep) values were higher in malignant lesions than in benign ones (all P < 0.001), but there were no significant statistical differences regarding volume fraction (Ve) (P = 0.866). The sensitivity and specificity of PWI combined with DWI (91.7% and 89.3%, respectively) were higher than that of PWI or DWI alone. The accuracy of PWI combined with DWI in predicting pathological results was significantly higher than that predicted by PWI or DWI alone.

CONCLUSION

DWI, combined with PWI, might possibly distinguish between benign and malignant BI-RADS 4 breast lesions at mammography.

Keywords: Magnetic resonance imaging, Breast diseases, Diffusion-weighted imaging, Perfusion-weighted imaging

Core Tip: Lesions of breast imaging reporting and data system (BI-RADS) at mammography only appeared a wide range of risk of being malignant (2%-96%). The specificity of magnetic resonance imaging in detecting breast is relatively low. This study aimed to evaluate the value of diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in diagnosing BI-RADS 4 breast lesions. The diagnostic efficacy of DWI and PWI were analyzed respectively and jointly. The results suggested DWI, combined with PWI, might possibly help distinguish benign breast lesions from malignant ones and provide clear diagnostic results for patients with potentially malignant BI-RADS 4 lesions at mammography.