Breast Lesion Characterisation with Diffusion Weighted Imaging Versus Dynamic Contrast Enhanced-MRI: A Prospective Observational Study in a Tertiary Care Hospital

Abstract

Purpose: Dynamic contrast-enhanced (DCE)-MRI has a promising role in breast cancer detection and lesion characterisation. Diffusion-weighted imaging (DWI) acts as an adjunct in the differentiation between benign and malignant lesions. The purpose of the study was to evaluate the efficacy of DCE-MRI and DWI in differentiating benign and malignant lesions. Methods: In a prospective study conducted between March 2019 and February 2020, 60 patients with breast lesions underwent DWI combined with DCE-MRI of the breast. The time–intensity curves were plotted. Lesions were classified according to the latest American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS; 5th edition). The results were compared with the histopathological diagnosis. The sensitivity and specificity of DWI, DCE-MRI, and combined DWI and DCE-MRI were calculated for detection of benign and malignant breast lesions. Results: Sixty patients underwent breast MRI in which 78 lesions were detected, out of which 28 were benign and 50 were malignant. Quantitative apparent diffusion coefficient measurement revealed 96% sensitivity and 82% specificity, with a positive predictive value of 92% and negative predictive value of 96%, for differentiating benign from malignant lesions. DCE-MRI findings showed 96% sensitivity and 78.5% specificity. The sensitivity of combined DWI and DCE-MRI was 98% and specificity was 86%, which was higher than DWI and DCE-MRI alone. Conclusion: Multiparametric MRI of the breast has very high sensitivity for detecting and characterising breast lesions as benign or malignant lesions. DWI had higher specificity than DCE-MRI, and the combined use of DWI and DCE-MRI had greater efficacy than DWI and DCE-MRI alone.