Differential diagnosis significance of 3.0T MRI united-sequence examination forbenign and malignant breast lesions_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Fumin ^1,2 ,  YIN Longlin ^1,2 , CHEN Xiaoyu ² , YANG Li ² , PU Yangmei ²

1. School of Medicine, University of Electronic Science and Technology of China, Chengdu 610000, P. R. China;
2. Department of Radiology, Affiliated Hospital of University of Electronic Science and Technology of China, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;

Corresponding author：

YIN Longlin, Email: yinlonglin@163.com

Keywords：

breast lesion; magnetic resonance imaging; dynamic enhancement scan; the time-signal intensity curve; apparent diffusion coefficient

DOI：

10.7507/1007-9424.201712018

Video：

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Objective To explore the differential diagnosis significance of 3.0T MRI united-sequences examination in the diagnosis of benign and malignant breast lesions. Methods A total of 67 breast lesions of 59 patients were collected prospectively, which be treated at the Sichuan Provincial People’s Hospital during July 2015 to January 2017. All patients were underwent bilateral breast 3.0T magnetic resonance plain scan, diffusion weighted imaging, and dynamic enhanced scan successively before surgical operation. Analysis of morphological features of the benign and malignant breast lesions, the time-signal intensity curve (TIC), the apparent diffusion coefficient (ADC), and the combination diagnosis of them were performed. Results Of all 59 patients, 67 lesions were confirmed by histopathology, including 18 benign lesions and 49 malignant lesions. The morphological features (including margin, shape, border, and evenness), the types of TIC of dynamic enhancement, and ADC value between the benign lesions and malignant lesions were statistically significant (P<0.05). The sensitivity and specificity of Fischer scoring system was 89.8% (44/49) and 61.1% (11/18) respectively. The sensitivity and specificity of TIC types was 83.7% (41/49) and 77.8% (14/18) respectively. The diagnostic threshold of ADC value was 1.012×10^–3 mm²/s, with the sensitivity and specificity for the diagnosis was 91.8% (45/49) and 83.3% (15/18) respectively. The sensitivity and specificity of the combination of Fischer scoring system and TIC type for diagnosis between benign and malignant breast lesions was 95.9% (47/49) and 72.2% (13/18) respectively. The sensitivity and specificity of the combination of Fischer scoring system, TIC type, and ADC value for benign and malignant breast lesions was 98.0% (48/49) and 83.3% (15/18) respectively. Conclusion The combination of Fischer scoring system, TIC type, and diffusion-weighted imaging for the differential diagnosis between benign lesions and malignant lesions was more effective than single imaging method.

Citation： WANG Fumin, YIN Longlin, CHEN Xiaoyu, YANG Li, PU Yangmei. Differential diagnosis significance of 3.0T MRI united-sequence examination forbenign and malignant breast lesions. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(7): 817-824. doi: 10.7507/1007-9424.201712018 Copy

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2.	陈晓煜, 谢欢, 印隆林. 乳腺病变的影像学检查评价. 实用医院临床杂志, 2016, 13(2): 178-182.
3.	Al-Khawari H, Athyal R, Kovacs A, et al. Accuracy of the Fischer scoring system and the Breast Imaging Reporting and Data System in identification of malignant breast lesions. Hematol Oncol Stem Cell Ther, 2009, 2(3): 403-410.
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6.	Kitagawa K, Sakuma H, Ishida N, et al. Contrast-enhanced high-resolution MRI of invasive breast cancer: correlation with histopathologic subtypes. AJR Am J Roentgenol, 2004, 183(6): 1805-1809.
7.	Kinoshita T, Yashiro N, Ihara N, et al. Diffusion-weighted half-Fourier single-shot turbo spin echo imaging in breast tumors: differentiation of invasive ductal carcinoma from fibroadenoma. J Comput Assist Tomogr, 2002, 26(6): 1042-1046.
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11.	Ma D, Lu F, Zou X, et al. Intravoxel incoherent motion diffusion-weighted imaging as an adjunct to dynamic contrast-enhanced MRI to improve accuracy of the differential diagnosis of benign and malignant breast lesions. Magn Reson Imaging, 2017, 36: 175-179.
12.	Bozkurt Bostan T, Koç G, Sezgin G, et al. Value of apparent diffusion coefficient values in differentiating malignant and benign breast lesions. Balkan Med J, 2016, 33(3): 294-300.
13.	Elsamaloty H, Elzawawi MS, Mohammad S, et al. Increasing accuracy of detection of breast cancer with 3-T MRI. AJR Am J Roentgenol, 2009, 192(4): 1142-1148.
14.	Furman-Haran E, Schechtman E, Kelcz F, et al. Magnetic resonance imaging reveals functional diversity of the vasculature in benign and malignant breast lesions. Cancer, 2005, 104(4): 708-718.
15.	Nunes LW, Schnall MD, Orel SG. Update of breast MR imaging architectural interpretation model. Radiology, 2001, 219(2): 484-494.
16.	钱吉芳, 马强华, 叶建军, 等. MRI 三维动态增强减影技术早期增强形态对乳腺癌的诊断价值. 实用放射学杂志, 2008, 24(4): 530-533.
17.	Sardanelli F, Giuseppetti GM, Panizza P, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol, 2004, 183(4): 1149-1157.
18.	Kuhl CK, Schild HH. Dynamic image interpretation of MRI of the breast. J Magn Reson Imaging, 2000, 12(6): 965-974.
19.	Milenković J, Hertl K, Košir A, et al. Characterization of spatiotemporal changes for the classification of dynamic contrast-enhanced magnetic-resonance breast lesions. Artif Intell Med, 2013, 58(2): 101-114.
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21.	徐光炎, 金琼英, 沈巨峰, 等. MRI 动态增强联合 DWI 对乳腺良恶性病变的鉴别. 中国中西医结合外科杂志, 2012, 18(2): 130-133.
22.	Komatsu S, Lee CJ, Ichikawa D, et al. Predictive value of the time-intensity curves on dynamic contrast-enhanced magnetic resonance imaging for lymphatic spreading in breast cancer. Surg Today, 2005, 35(9): 720-724.
23.	Sinkus R, Tanter M, Siegmann K, et al. Breast cancer exhibits liquid-like mechanical properties-a comparative study between MR-mammography and MR-elastography. Proc Intl Soc Mag Reson Med, 2007, 15: 963.
24.	Pereira FP, Martins G, Carvalhaes de Oliveira Rde V. Diffusion magnetic resonance imaging of the breast. Magn Reson Imaging Clin N Am, 2011, 19(1): 95-110.
25.	Fornasa F, Pinali L, Gasparini A, et al. Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation. Radiol Med, 2011, 116(2): 264-275.
26.	Kuroki Y, Nasu K, Kuroki S, et al. Diffusion-weighted imaging of breast cancer with the sensitivity encoding technique: analysis of the apparent diffusion coefficient value. Magn Reson Med Sci, 2004, 3(2): 79-85.
27.	Furman-Haran E, Degani H, Kirshenbaum K, et al. A two center clinical testing of the 3TP method for contrast enhanced breast MRI. Proc Intl Soc Mag Reson Med, 2001, 9: 566.
28.	Spick C, Bickel H, Pinker K, et al. Diffusion-weighted MRI of breast lesions: a prospective clinical investigation of the quantitative imaging biomarker characteristics of reproducibility, repeatability, and diagnostic accuracy. NMR Biomed, 2016, 29(10): 1445-1453.
29.	郭勇, 蔡祖龙, 蔡幼铨, 等. 弥散加权成像鉴别乳腺良恶性病变的价值初探. 中华放射学杂志, 2001, 35(2): 132-135.
30.	赵合保, 赵向荣, 李保卫, 等. 乳腺 MR 动态增强技术联合扩散加权成像的临床应用价值. 中国实验诊断学, 2013, 17(8): 1429-1431.
31.	林卫勇. 联合 MR 动态增强扫描、弥散加权成像在乳腺良恶性病变诊断中的应用价值. 中国现代医生, 2014, 52(29): 45-47, 50.

1. Lynch BM, Neilson HK, Friedenreich CM. Physical activity and breast cancer prevention. Recent Results Cancer Res, 2011, 186: 13-42.
2. 陈晓煜, 谢欢, 印隆林. 乳腺病变的影像学检查评价. 实用医院临床杂志, 2016, 13(2): 178-182.
3. Al-Khawari H, Athyal R, Kovacs A, et al. Accuracy of the Fischer scoring system and the Breast Imaging Reporting and Data System in identification of malignant breast lesions. Hematol Oncol Stem Cell Ther, 2009, 2(3): 403-410.
4. 张丽, 韩立新, 曹惠霞, 等. Fischer’s 评分结合 MR 影像报告数据系统在乳腺病灶定性中的应用价值. 临床放射学杂志, 2013, 32(10): 1432-1435.
5. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics, 1977, 33(1): 159-174.
6. Kitagawa K, Sakuma H, Ishida N, et al. Contrast-enhanced high-resolution MRI of invasive breast cancer: correlation with histopathologic subtypes. AJR Am J Roentgenol, 2004, 183(6): 1805-1809.
7. Kinoshita T, Yashiro N, Ihara N, et al. Diffusion-weighted half-Fourier single-shot turbo spin echo imaging in breast tumors: differentiation of invasive ductal carcinoma from fibroadenoma. J Comput Assist Tomogr, 2002, 26(6): 1042-1046.
8. Lee SG, Orel SG, Woo IJ, et al. MR imaging screening of the contralateral breast in patients with newly diagnosed breast cancer: preliminary results. Radiology, 2003, 226(3): 773-778.
9. Greenwood HI, Freimanis RI, Carpentier BM, et al. Clinical breast magnetic resonance imaging: technique, indications, and future applications. Semin Ultrasound CT MR, 2018, 39(1): 45-59.
10. Chhor CM, Mercado CL. Abbreviated MRI protocols: wave of the future for breast cancer screening. AJR Am J Roentgenol, 2017, 208(2): 284-289.
11. Ma D, Lu F, Zou X, et al. Intravoxel incoherent motion diffusion-weighted imaging as an adjunct to dynamic contrast-enhanced MRI to improve accuracy of the differential diagnosis of benign and malignant breast lesions. Magn Reson Imaging, 2017, 36: 175-179.
12. Bozkurt Bostan T, Koç G, Sezgin G, et al. Value of apparent diffusion coefficient values in differentiating malignant and benign breast lesions. Balkan Med J, 2016, 33(3): 294-300.
13. Elsamaloty H, Elzawawi MS, Mohammad S, et al. Increasing accuracy of detection of breast cancer with 3-T MRI. AJR Am J Roentgenol, 2009, 192(4): 1142-1148.
14. Furman-Haran E, Schechtman E, Kelcz F, et al. Magnetic resonance imaging reveals functional diversity of the vasculature in benign and malignant breast lesions. Cancer, 2005, 104(4): 708-718.
15. Nunes LW, Schnall MD, Orel SG. Update of breast MR imaging architectural interpretation model. Radiology, 2001, 219(2): 484-494.
16. 钱吉芳, 马强华, 叶建军, 等. MRI 三维动态增强减影技术早期增强形态对乳腺癌的诊断价值. 实用放射学杂志, 2008, 24(4): 530-533.
17. Sardanelli F, Giuseppetti GM, Panizza P, et al. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol, 2004, 183(4): 1149-1157.
18. Kuhl CK, Schild HH. Dynamic image interpretation of MRI of the breast. J Magn Reson Imaging, 2000, 12(6): 965-974.
19. Milenković J, Hertl K, Košir A, et al. Characterization of spatiotemporal changes for the classification of dynamic contrast-enhanced magnetic-resonance breast lesions. Artif Intell Med, 2013, 58(2): 101-114.
20. 张显文, 李红, 李娜. DCE-MRI 结合 1H-MRS 对乳腺良恶性肿瘤的诊断价值. 中国妇幼保健, 2013, 28(20): 3355-3358.
21. 徐光炎, 金琼英, 沈巨峰, 等. MRI 动态增强联合 DWI 对乳腺良恶性病变的鉴别. 中国中西医结合外科杂志, 2012, 18(2): 130-133.
22. Komatsu S, Lee CJ, Ichikawa D, et al. Predictive value of the time-intensity curves on dynamic contrast-enhanced magnetic resonance imaging for lymphatic spreading in breast cancer. Surg Today, 2005, 35(9): 720-724.
23. Sinkus R, Tanter M, Siegmann K, et al. Breast cancer exhibits liquid-like mechanical properties-a comparative study between MR-mammography and MR-elastography. Proc Intl Soc Mag Reson Med, 2007, 15: 963.
24. Pereira FP, Martins G, Carvalhaes de Oliveira Rde V. Diffusion magnetic resonance imaging of the breast. Magn Reson Imaging Clin N Am, 2011, 19(1): 95-110.
25. Fornasa F, Pinali L, Gasparini A, et al. Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation. Radiol Med, 2011, 116(2): 264-275.
26. Kuroki Y, Nasu K, Kuroki S, et al. Diffusion-weighted imaging of breast cancer with the sensitivity encoding technique: analysis of the apparent diffusion coefficient value. Magn Reson Med Sci, 2004, 3(2): 79-85.
27. Furman-Haran E, Degani H, Kirshenbaum K, et al. A two center clinical testing of the 3TP method for contrast enhanced breast MRI. Proc Intl Soc Mag Reson Med, 2001, 9: 566.
28. Spick C, Bickel H, Pinker K, et al. Diffusion-weighted MRI of breast lesions: a prospective clinical investigation of the quantitative imaging biomarker characteristics of reproducibility, repeatability, and diagnostic accuracy. NMR Biomed, 2016, 29(10): 1445-1453.
29. 郭勇, 蔡祖龙, 蔡幼铨, 等. 弥散加权成像鉴别乳腺良恶性病变的价值初探. 中华放射学杂志, 2001, 35(2): 132-135.
30. 赵合保, 赵向荣, 李保卫, 等. 乳腺 MR 动态增强技术联合扩散加权成像的临床应用价值. 中国实验诊断学, 2013, 17(8): 1429-1431.
31. 林卫勇. 联合 MR 动态增强扫描、弥散加权成像在乳腺良恶性病变诊断中的应用价值. 中国现代医生, 2014, 52(29): 45-47, 50.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Differential diagnosis significance of 3.0T MRI united-sequence examination forbenign and malignant breast lesions

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