Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Apr 1;27(7):1941-1948.
doi: 10.1158/1078-0432.CCR-20-3037. Epub 2021 Jan 14.

Diffusion-weighted Imaging Allows for Downgrading MR BI-RADS 4 Lesions in Contrast-enhanced MRI of the Breast to Avoid Unnecessary Biopsy

Paola Clauser  1 , Barbara Krug  2 , Hubert Bickel  1 , Matthias Dietzel  3 , Katja Pinker  4 , Victor-Frederic Neuhaus  2 , Maria Adele Marino  5 , Marco Moschetta  6 , Nicoletta Troiano  6 , Thomas H Helbich  1 , Pascal A T Baltzer  7
Affiliations
Multicenter Study

Diffusion-weighted Imaging Allows for Downgrading MR BI-RADS 4 Lesions in Contrast-enhanced MRI of the Breast to Avoid Unnecessary Biopsy

Paola Clauser et al. Clin Cancer Res. .

Abstract

Purpose: Diffusion-weighted imaging with the calculation of an apparent diffusion coefficient (ADC) has been proposed as a quantitative biomarker on contrast-enhanced MRI (CE-MRI) of the breast. There is a need to approve a generalizable ADC cutoff. The purpose of this study was to evaluate whether a predefined ADC cutoff allows downgrading of BI-RADS 4 lesions on CE-MRI, avoiding unnecessary biopsies.

Experimental design: This was a retrospective, multicentric, cross-sectional study. Data from five centers were pooled on the individual lesion level. Eligible patients had a BI-RADS 4 rating on CE-MRI. For each center, two breast radiologists evaluated the images. Data on lesion morphology (mass, non-mass), size, and ADC were collected. Histology was the standard of reference. A previously suggested ADC cutoff (≥1.5 × 10-3 mm2/second) was applied. A negative likelihood ratio of 0.1 or lower was considered as a rule-out criterion for breast cancer. Diagnostic performance indices were calculated by ROC analysis.

Results: There were 657 female patients (mean age, 42; SD, 14.1) with 696 BI-RADS 4 lesions included. Disease prevalence was 59.5% (414/696). The area under the ROC curve was 0.784. Applying the investigated ADC cutoff, sensitivity was 96.6% (400/414). The potential reduction of unnecessary biopsies was 32.6% (92/282).

Conclusions: An ADC cutoff of ≥1.5 × 10-3 mm2/second allows downgrading of lesions classified as BI-RADS 4 on breast CE-MRI. One-third of unnecessary biopsies could thus be avoided.

PubMed Disclaimer

Conflict of interest statement

Clauser P. received speaker’s fee from Siemens Healthcare GmBH.

The other authors declare no potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart showing the included and excluded cases. The standard of reference was histopathology. BI-RADS: Breast Imaging Reporting and Data System.
Figure 2
Figure 2
Area under the receiver operating characteristics curve for the apparent diffusion coefficient (ADC) values to distinguish benign from malignant breast lesions initially classified as suspicious (BI-RADS 4) at contrast-enhanced magnetic resonance imaging.
Figure 3
Figure 3
Fagan Nomogram showing the pre- and post-test probabilities of malignancy overall and separately in the included datasets from the different centers.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bakker MF, de Lange SV, Pijnappel RM, et al.Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019;381(22):2091–2102. - PubMed
    1. Comstock CE, Gatsonis C, Newstead GM, et al.Comparison of Abbreviated Breast MRI vs Digital Breast Tomosynthesis for Breast Cancer Detection Among Women With Dense Breasts Undergoing Screening. JAMA. 2020;323(8):746–756. - PMC - PubMed
    1. Amitai Y, Scaranelo A, Menes TS, et al.Can breast MRI accurately exclude malignancy in mammographic architectural distortion? Eur Radiol. 2020;30(5):2751–2760. - PubMed
    1. Niell BL, Bhatt K, Dang P, Humphrey K. Utility of Breast MRI for Further Evaluation of Equivocal Findings on Digital Breast Tomosynthesis. AJR Am J Roentgenol. 2018;211(5):1171–1178. - PubMed
    1. Bennani-Baiti B, Bennani-Baiti N, Baltzer PA. Diagnostic Performance of Breast Magnetic Resonance Imaging in Non-Calcified Equivocal Breast Findings: Results from a Systematic Review and Meta-Analysis. PloS One. 2016;11(8):e0160346. - PMC - PubMed

Publication types