Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer

Naoko Mori; Shunji Mugikura; Chiaki Takasawa; Minoru Miyashita; Akiko Shimauchi; Hideki Ota; Takanori Ishida; Atsuko kasajima; Kei Takase; Tetsuya Kodama; Shoki Takahashi

doi:10.1007/s00330-015-3847-4

Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer

Eur Radiol. 2016 Feb;26(2):331-9. doi: 10.1007/s00330-015-3847-4. Epub 2015 May 30.

Authors

Affiliations

¹ Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan. naokomori7127@gmail.com.
² Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
³ Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
⁴ Department of Pathology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
⁵ Department of Biomedical Engineering, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.

PMID: 26024846
DOI: 10.1007/s00330-015-3847-4

Abstract

Objectives: To evaluate whether visual assessment of T2-weighted imaging (T2WI) or an apparent diffusion coefficient (ADC) could predict lymphovascular invasion (LVI) status in cases with clinically node-negative invasive breast cancer.

Materials and methods: One hundred and thirty-six patients with 136 lesions underwent MRI. Visual assessment of T2WI, tumour-ADC, peritumoral maximum-ADC and the peritumour-tumour ADC ratio (the ratio between them) were compared with LVI status of surgical specimens.

Results: No significant relationship was found between LVI and T2WI. Tumour-ADC was significantly lower in the LVI-positive (n = 77, 896 ± 148 × 10(-6) mm(2)/s) than the LVI-negative group (n = 59, 1002 ± 163 × 10(-6) mm(2)/s; p < 0.0001). Peritumoral maximum-ADC was significantly higher in the LVI-positive (1805 ± 355 × 10(-6) mm(2)/s) than the LVI-negative group (1625 ± 346 × 10(-6) mm(2)/s; p = 0.0003). Peritumour-tumour ADC ratio was significantly higher in the LVI-positive (2.05 ± 0.46) than the LVI-negative group (1.65 ± 0.40; p < 0.0001). Receiver operating characteristic curve analysis revealed that the area under the curve (AUC) of the peritumour-tumour ADC ratio was the highest (0.81). The most effective threshold for the peritumour-tumour ADC ratio was 1.84, and the sensitivity, specificity, positive predictive value and negative predictive value were 77% (59/77), 76% (45/59), 81% (59/73) and 71% (45/63), respectively.

Conclusions: We suggest that the peritumour-tumour ADC ratio can assist in predicting LVI status on preoperative imaging.

Key points: • Tumour ADC was significantly lower in LVI-positive than LVI-negative breast cancer. • Peritumoral maximum-ADC was significantly higher in LVI-positive than LVI-negative breast cancer. • Peritumour-tumour ADC ratio was significantly higher in LVI-positive breast cancer. • Diagnostic performance of the peritumour-tumour ADC ratio was highest for positive LVI. • Peritumour-tumour ADC ratio showed higher diagnostic ability in postmenopausal than premenopausal patients.

Keywords: Beast Cancer; Diffusion-weighted MRI; Embolism; Lymphatic Vessels; Tumour.

Publication types

Evaluation Study

MeSH terms

Adult
Aged
Area Under Curve
Breast Neoplasms / pathology*
Diffusion Magnetic Resonance Imaging / methods
Female
Humans
Image Interpretation, Computer-Assisted / methods
Lymphatic Metastasis
Lymphatic Vessels / pathology
Middle Aged
Neoplasm Invasiveness
Observer Variation
ROC Curve
Retrospective Studies
Sensitivity and Specificity