Evaluation of High-risk (B3) Breast Lesions on MRI: The Role of Diffusion-weighted Imaging and Texture Analysis Features in Predicting Upgrade to Malignancy.

Objective: This study aimed to investigate the potential malignancy associated with high-risk breast lesions using breast magnetic resonance imaging (MRI) characteristics, apparent diffusion coefficient (ADC) measurements, and texture analysis parameters.

Methods: This retrospective study included 40 patients with 41 lesions diagnosed as high-risk lesions after needle biopsy. All the patients underwent surgery. Based on the histopathologic results of the surgical excision, the patients were divided into 2 groups: those diagnosed with malignancy and those who were not. The MRI characteristics of the lesions were recorded. The ADC values of the lesions were measured. Textural analysis of the lesions was also performed.

Results: Fourteen lesions (34.1%) were upgraded to malignancy. The median ADCmean values ​​in the malignant group were 1.114 × 10-3 versus 1.383×10-3 mm2/s in the nonmalignant group, which was statistically significant (P < 0.001). The cutoff value for the mean ADC was 1.163 ×10-3 mm2/s. The sensitivity and specificity were 71.4% and 85.2%, respectively. Among the texture analysis parameters, kurtosis values obtained from images on the ADC map and the first subtracted dynamic contrast-enhanced (DCE) series and contrast values obtained from images on the second subtracted DCE series were found to be statistically significant (P = 0.016, P = 0.019, and P = 0.045, respectively) between the malignant and nonmalignant groups.

Conclusions: ADC measurements and texture analysis parameters provide useful diagnostic information for determining which high-risk breast lesions will progress to malignancy.