MR diffusion-weighted imaging precision in BIRADS downstaging

Breast cancer is a major cause of both morbidity and mortality. Therefore, it is essential to promptly identify breast cancer in order to implement a more cautious surgical approach for disease treatment. Breast ultrasonography examination has long been used as a supplementary technique to mammography to evaluate palpable or mammographically detectable breast masses. Presently, Breast MRI has become an essential instrument for the detection and analysis of breast cancer. Diffusion-weighted imaging (DWI) is MRI technique that quantifies the movement of water molecules within tissue. It can provide valuable information about the density, viscosity, integrity of membranes, and microstructure of tissues. This study included sixty patients with Equivocal/high BIRADS lesions, underwent Mammography and /or U/S, CEMRI with DWI. The aim of this study was to disclose MRDWI potency in depiction and assessment of different breast lesions unaccompanied by contrast-enhanced MRI with a view to avoid the high cost of the MRI contrast, lessen the number of needless biopsies and probably reclassify breast lesions of high BIRADS categories. This prospective study included 58 patients (with 60 breast lesions), who came with sono-mammography breast lesions of BIRADS lesions > 2, comparison between sono-mammographic BIRADS and MRI BIRADS was done, where 40 cases were downgraded by MRBIRADS. On paralleling MRDWI unescorted by contrast-enhanced MRI with sono-mammographic BIRADS, 36 cases were downgraded. Correlation between pathology of the biopsied lesions with sono-mammography, MR BIRADS and MRDWI was done as well. Sono–mammography shows 88.9% sensitivity and 61.9% specificity with accuracy of 77.7%. Combined CE –MRI and DWI shows 94% sensitivity and 97.6% specificity with accuracy of 96%. While DWI solely shows 88.9% sensitivity and 90.5% specificity with accuracy of 96%. The cutoff value of ADC for prediction of malignancy was 0.9 with 94% sensitivity, 87% specificity and 83.3 accuracy. CEMRI is un-debatably effective in depicting and discriminating indeterminate breast lesions chiefly when combined with DWI. Yet, with the high expense of the contrast and in the event of contrast contraindications or unavailability, DWI has proven to be a convenient substitute for CE-MRI aiding in rendering the breast lesion BIRADS downgraded with diminishing the unneeded biopsies.