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Abstract
Purpose
To correlate the apparent diffusion coefficient (ADC) value and peak standardized uptake value (pSUV) with histologic grade and clinical prognostic factors of breast ductal carcinoma.
Materials and Methods
Fifty breast cancers of 49 patients (age range: 37-83 years, mean: 53 years) were studied retrospectively. The breast cancers included 4 ductal carcinoma in situ (DCIS) and 46 invasive ductal carcinomas (IDC). The relationships for both pSUV and ADC values with clinicopathological prognostic factors (age, tumor size, histologic grade, nodal metastasis, hormone receptor and HER-2 neu status) were statistically evaluated.
Results
The histologic type of ductal carcinoma include DCIS (n = 4) and IDC (n = 46, grade 1 = 10, grade 2 = 13, and grade 3 = 23). pSUV was associated with histologic grade and tumor size and the ADC value was associated with histologic grade (p < 0.05). As the histologic grade becomes higher, the ADC values decrease, while pSUV and pSUV/ADC increase (p < 0.05). The characterization accuracy of pSUV/ADC (90.2%) was higher than pSUV (86.7%) and ADC values (25.4%) alone for the diagnosis of breast cancer (p < 0.05).
Figures and Tables
Fig. 1
A 50-year-old woman having 1.0 cm grade I IDC of the right breast.
A. The axial dynamic-enhanced the T1-weighted gradient-echo subtraction image for the first post-contrast acquisition shows a heterogeneous enhancing irregular mass with a spiculated margin (arrow).
B. On the axial PET/CT fusion image, the mass shows hypermetabolism with a pSUV of 1.5 (arrow).
C. The DWI (b = 1000 mm2/s) shows diffusion restriction with an intermediate signal intensity lesion (arrow).
D. On the ADC map, the ADC value of the mass was 1.47 × 10-3 mm2/s (arrow).
E. Most of tumor reveals tubule formation, moderate variation in nuclear size and shape, with rare mitotic figures. According to Nottingham modification of Scarff-Bloom-Richardson system, histologic grade I is given (1 + 2 + 1 = 4) (H&E, × 100).
Note.-ADC = apparent diffusion coefficient, DWI = diffusion weighted image, IDC = invasive ductal carcinoma, PET = positron emission tomography, pSUV = peak standardized uptake value
Fig. 2
A 55-year-old woman having a 2.6 cm IDC of the left breast.
A. The axial dynamic-enhanced T1-weighted gradient-echo subtraction image of the first post-contrast acquisition shows a homogeneously enhancing mass with stronger enhancement at its rim with a spiculated margin (arrow).
B. On the axial PET/CT fusion image, the mass shows hypermetabolism with a pSUV of 11.9 (arrow).
C. The DWI (b = 1000 mm2/s) shows diffusion restriction with bright signal intensity of the mass (arrow).
D. The ADC value of the mass was 0.54 × 10-3 mm2/s (arrow).
E. Microscopical findings reveals rare tubule formation, marked variation of nuclear size and shape, and frequent mitotic figures with atypical mitosis. According to Nottingham modification of Scarff-Bloom-Richardson system, histologic grade III is given (3 + 3 + 3 = 9) (H&E, × 200).
Note.-ADC = apparent diffusion coefficient, DWI = diffusion weighted image, IDC = invasive ductal carcinoma, PET = positron emission tomography, pSUV = peak standardized uptake value
Fig. 3
Distribution of ADC value and pSUV for DCIS and grade 1, 2 and 3 of IDC.
A. ADC value shows a negative correlation with histologic grade (Pearson's correlation coefficient = -0.710, p < 0.05).
B. pSUV was correlated with histologic grade (Pearson's correlation coefficient = 0.530, p < 0.05).
Note.-ADC = apparent diffusion coefficient, DCIS = ductal carcinoma in situ, IDC = invasive ductal carcinoma, pSUV = peak standardized uptake value
Fig. 4
Scatter plots of pSUV, ADC and pSUV/ADC.
A. Scatter plots of pSUV and ADC with regression line (y = 0.863 - 0.27x, R2 = 0.213, p < 0.05). pSUV values are shown to be significantly increasing and ADC values are shown to be decreasing as the histologic grade becomes higher.
B. pSUV/ADC shows a positive correlation with histologic grade (Pearson's correlation coefficient = 0.535, p < 0.05).
Note.-ADC = apparent diffusion coefficient, DCIS = ductal carcinoma in situ, IDC = invasive ductal carcinoma, pSUV = peak standardized uptake value
Fig. 5
pSUV and pSUV/ADC having high accuracy for predicting a histologic grade of breast cancer (area under the curve are each 0.867 and 0.902). Note that the ADC values show low diagnostic performance (area under the curve 0.254).
Note.-ADC = apparent diffusion coefficient, pSUV = peak standardized uptake value, ROC = receiver operating characteristic
Table 1
Association of pSUV and ADC Values with Clinicopathological Factors in Breast Cancer
Data are medians, with IQRs in parentheses.
Note.-*Significant difference.
ADC = apparent diffusion coefficient, DCIS = ductal carcinoma in situ, ER = estrogen receptor, HER-2 = human epidermal growth factor receptor 2, IDC = invasive ductal carcinoma, PR = progesterone receptor, pSUV = peak standardized uptake value
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