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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.

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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

References

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