Diffusion Weighted MR Imaging of Breast and Correlation of Prognostic Factors in Breast Cancer

Abstract

Background: Through Diffusion Weighted Imaging (DWI), information related to early molecular changes, changes in the permeability of cell membranes, and early morphologic and physiologic changes such as cell swelling can be obtained. Aims: We investigated the correlation between the prognostic factors of breast cancer and apparent diffusion coefficient (ADC) in DWI sequences of malignant lesions. Study Design: Retrospective cross-sectional study. Methods: Patients who were referred to our clinic between September 2012 and September 2013, who underwent dynamic breast MRI before or after biopsy and whose biopsy results were determined as malignant, were included in our study. Before the dynamic analysis, DWI sequences were taken. ADC relationship with all prognostic factors was investigated. Pearson correlation test was used to compare the numerical data, while Spearman correlation and Fisher exact tests were used to compare the categorical data. The advanced relationships were evaluated with linear regression analysis and univariate analysis. The efficiency of the parameters was evaluated using ROC analysis. The significance level (P) was accepted as 0.05. Results: In total, 41 female patients with an average age of 49.4 years (age interval 21-77) and 44 lesions were included into the study. In the Pearson correlation test, no statistically significant difference was determined between ADC and the patient’s age and tumor size. In the Spearman correlation test, a statistically significant difference was determined between nuclear grade (NG) and ADC (r=-0.424, p=0.04); no statistically significant correlation was observed between the other prognostic factors with each other and ADC values. In the linear regression analysis, the relationship of NG with ADC was found to be more significant alone than when comparing all parameters (corrected r2=0.196, p=0.005). Further evaluations between the NG and ADC correlation were carried out with ROC analysis. A statistically significant difference was determined when NG 1 separately was compared with NG 2 and 3 (p=0.03). A statistically significant difference was also determined (p=0.05) in the comparison of NG 1 with only NG 3. No statistically significant difference was determined when NG 2 separately was compared with NG 1 and NG 3 and when NG 3 separately was compared with NG 1 and 2 (p=0.431, p=0.097), Conclusion: We found that ADC values obtained by breast DWI showed a higher correlation with the NG of breast cancer, which is an important factor in the patient’s treatment. Predictions can be made about NG by analyzing the ADC values. Additional studies are needed, however, and the ADC value of the lesion can be used as a prognostic factor proving the aggressiveness.