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Original Research

Diffusion-weighted Imaging of Invasive Breast Cancer: Relationship to Distant Metastasis–free Survival

Published Online:Mar 12 2019https://doi.org/10.1148/radiol.2019181706
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Figure 1:

Figure 1: Flowchart of study population. DWI = diffusion-weighted imaging.

Figure 2a:

Figure 2a: Preoperative images of right breast in 41-year-old woman with breast cancer. (a) Axial T1-weighted contrast-enhanced subtraction MR image shows heterogeneous enhancing mass in right upper breast. (b) Axial diffusion-weighted image (b value = 1000 sec/mm2) shows mass with high signal intensity. (c) Apparent diffusion coefficient (ADC) map shows mass with low signal intensity. For ADC measurement, the largest cross-section of tumor was chosen, and a region of interest (green) was manually drawn to encompass entire cross-section of lesion. Mean ADC, minimum ADC, and maximum ADC were 0.892 × 10−3 mm2/sec, 0.623 × 10−3 mm2/sec, and 1.311× 10−3 mm2/sec, respectively. ADC difference value (difference between minimum and maximum ADC) was 0.688 × 10−3 mm2/sec.

Figure 2b:

Figure 2b: Preoperative images of right breast in 41-year-old woman with breast cancer. (a) Axial T1-weighted contrast-enhanced subtraction MR image shows heterogeneous enhancing mass in right upper breast. (b) Axial diffusion-weighted image (b value = 1000 sec/mm2) shows mass with high signal intensity. (c) Apparent diffusion coefficient (ADC) map shows mass with low signal intensity. For ADC measurement, the largest cross-section of tumor was chosen, and a region of interest (green) was manually drawn to encompass entire cross-section of lesion. Mean ADC, minimum ADC, and maximum ADC were 0.892 × 10−3 mm2/sec, 0.623 × 10−3 mm2/sec, and 1.311× 10−3 mm2/sec, respectively. ADC difference value (difference between minimum and maximum ADC) was 0.688 × 10−3 mm2/sec.

Figure 2c:

Figure 2c: Preoperative images of right breast in 41-year-old woman with breast cancer. (a) Axial T1-weighted contrast-enhanced subtraction MR image shows heterogeneous enhancing mass in right upper breast. (b) Axial diffusion-weighted image (b value = 1000 sec/mm2) shows mass with high signal intensity. (c) Apparent diffusion coefficient (ADC) map shows mass with low signal intensity. For ADC measurement, the largest cross-section of tumor was chosen, and a region of interest (green) was manually drawn to encompass entire cross-section of lesion. Mean ADC, minimum ADC, and maximum ADC were 0.892 × 10−3 mm2/sec, 0.623 × 10−3 mm2/sec, and 1.311× 10−3 mm2/sec, respectively. ADC difference value (difference between minimum and maximum ADC) was 0.688 × 10−3 mm2/sec.

Figure 3a:

Figure 3a: Preoperative images in 54-year-old woman with distant metastasis. (a) Axial maximum intensity projection image from contrast-enhanced MRI shows irregular enhancing mass in left lateral breast (arrow). (b) Axial diffusion-weighted image (b value = 1000 sec/mm2) shows mass with high signal intensity (arrow). Apparent diffusion coefficient difference value was 0.822 × 10−3 mm2/sec. Surgical histopathologic examination showed 3.1-cm invasive ductal carcinoma with histologic grade 3 that was estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 positive. Ki-67 and p53 indexes were 30% and 50%, respectively. Axillary lymph node metastasis was found in four of 17 resected nodes. This patient was found to have bone metastasis after a follow-up of 30 months. (c) Axial PET/CT scan shows hypermetabolic lesion (arrow) in right femoral head.

Figure 3b:

Figure 3b: Preoperative images in 54-year-old woman with distant metastasis. (a) Axial maximum intensity projection image from contrast-enhanced MRI shows irregular enhancing mass in left lateral breast (arrow). (b) Axial diffusion-weighted image (b value = 1000 sec/mm2) shows mass with high signal intensity (arrow). Apparent diffusion coefficient difference value was 0.822 × 10−3 mm2/sec. Surgical histopathologic examination showed 3.1-cm invasive ductal carcinoma with histologic grade 3 that was estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 positive. Ki-67 and p53 indexes were 30% and 50%, respectively. Axillary lymph node metastasis was found in four of 17 resected nodes. This patient was found to have bone metastasis after a follow-up of 30 months. (c) Axial PET/CT scan shows hypermetabolic lesion (arrow) in right femoral head.

Figure 3c:

Figure 3c: Preoperative images in 54-year-old woman with distant metastasis. (a) Axial maximum intensity projection image from contrast-enhanced MRI shows irregular enhancing mass in left lateral breast (arrow). (b) Axial diffusion-weighted image (b value = 1000 sec/mm2) shows mass with high signal intensity (arrow). Apparent diffusion coefficient difference value was 0.822 × 10−3 mm2/sec. Surgical histopathologic examination showed 3.1-cm invasive ductal carcinoma with histologic grade 3 that was estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 positive. Ki-67 and p53 indexes were 30% and 50%, respectively. Axillary lymph node metastasis was found in four of 17 resected nodes. This patient was found to have bone metastasis after a follow-up of 30 months. (c) Axial PET/CT scan shows hypermetabolic lesion (arrow) in right femoral head.

Figure 4:

Figure 4: Kaplan-Meier curves for distant metastasis–free survival based on apparent diffusion coefficient (ADC) difference value in 258 patients with invasive breast cancer. The numbers of survivors at each time point are shown below the graph.