Role of Diffusion Weighted Imaging in the Differentiation between Benign and Malignant Breast Masses in Correlation with Sono-Mammography

Abstract
Background: Evaluation of the role of DWI in differe-ntiation between benign and malignant breast lesions with Sono-mammographic and pathologic correlation.
Aim of Study: To evaluate the role of diffusion weighted imaging in the differentiation between benign and malignant breast lesions with sono-mammographic and histopathologic correlation.
Material and Methods: This study included 30 females (with 31 breast lesions). Their ages ranged from 21 to 65 years. They were subjected to history, Clinical examination, sono-mammography, MRI and histopathology. The Sono-mammographic categories included were 3, 4 and 5. We used 1.5 T MRI system and the sequences performed included T1 W, T2 W and STIR. The DWI was done using b-values 0, 500, 1000s/mm2 then the ADC values were calculated. For statistical analysis we used t-test and ROC curve.
Results: The mean age was 42.6 years. The most common clinical presentation was palpable breast lump (16 patients). We had BIRADS 3 (6 lesions), BIRADS 4 (17 lesions), BIRADS 5 (8 lesions). By histopathologic examination we had 9 benign neoplasm, 10 malignant neoplasm, 5 post con-servative changes, 3 fibrocystic changes, 1 granulomatous mastitis, 2 inflammatory hyperplastic changes & 1 localized adenosis. The mean ADC for benign lesions was 1.42 x10-3 mm2 and for malignant lesions was 0.88x10-3 mm2. The cut off value between malignant lesions and benign lesions was £1.175. Finally there was weak negative statistical correlation between sono-mammographic BIRADS results and the ADC values.
Conclusion: The DWI and ADC values are useful tools for the differentiation between benign and malignant breast lesions especially in patients with contrast intolerance. These techniques showed considerable specificity and positive predictive values when compared to Sono-mammographic BIRADS and histo-pathologic results.