Association between Apparent Diffusion Coefficient Values on Diffusion Weighted Imaging and Prognostic Factors of Breast Cancer

Full Article

WK Ng, CKK Wong, EPY Fung, CW Wong, WS Mak, KM Kwok, HS Lam, HY Cho

Hong Kong J Radiol 2019;22:98-106

https://doi.org/10.12809/hkjr1916975

Objective: To evaluate the association between apparent diffusion coefficient (ADC) values and prognostic factors of breast cancer.
Methods: All patients with breast cancer who underwent breast magnetic resonance imaging and subsequent surgery in Kwong Wah Hospital from January 2012 to December 2016 were retrospectively reviewed. The ADC values of the malignant lesions were recorded and compared with tumour size (≥2 cm, <2 cm), tumour grading (modified Bloom-Richardson-Elston grade 1, 2, 3), tumour aggressiveness (ductal in situ carcinoma and grade 1 invasive carcinomas, grade 2-3 invasive carcinomas), axillary lymph node status (positive, negative), oestrogen receptor expression (positive, negative), progesterone receptor expression (positive, negative), and human epidermal growth factor receptor 2 receptor status (positive, negative).
Results: 100 patients with 102 lesions were included in this study, of which 88 were invasive carcinomas and 14 were ductal carcinoma in situ. There was a significant difference between mean ADC value and tumour grading (p < 0.001), with an inverse correlation (Kendall’s tau-b = -0.339; p < 0.001). The association was independent of other prognostic factors, as shown by multiple linear regression. The mean ADC value of axillary lymph node–positive breast cancers was significantly lower than that of axillary lymph node–negative cancers (p = 0.023), with a significant inverse correlation (r_pb = -0.226; p=0.023), but the association was not independent of other prognostic factors. ADC value showed good predictive value in predicting tumour aggressiveness, with an area under the receiver operating characteristic curve of 0.717.
Conclusion: Lower ADC values are well correlated with higher histological grade; therefore, ADC can be considered as a promising prognostic parameter for the evaluation of invasive breast cancer.

Author affiliation(s):
WK Ng: Department of Radiology, Tuen Mun Hospital, Tuen Mun, Hong Kong
CKK Wong, EPY Fung, CW Wong, WS Mak, KM Kwok, HS Lam, HY Cho: Department of Diagnostic and Interventional Radiology, Kwong Wah Hospital, Yaumatei, Hong Kong

中文摘要

彌散加權成像的表觀擴散系數與乳腺癌預後因素的關係

吳詠淇、黃卓琦、馮寶恩、黃鎮威、麥詠詩、郭勁明、林漢城、曹慶恩

目的：評估表觀彌散系數（ADC）與乳腺癌預後因素的關係。
方法：回顧分析2012年1月至2016年12月在廣華醫院接受乳腺磁共振成像和後續手術的所有乳腺癌患者，記錄並從以下項目比較惡性病灶的ADC值，包括腫瘤大小（≥2 cm比<2 cm）、改良版 Bloom-Richardson-Elston腫瘤分級（1至3級）、腫瘤侵襲性（乳腺導管原位癌／1級浸潤性癌比2至3級浸潤性癌）、腋窩淋巴結狀態（陽性比陰性）、雌激素受體表達（陽性比陰性）、孕激素受體表達（陽性比陰性）和人類表皮生長因子受體2受體狀態（陽性比陰性）。
結果：納入100例共102個病灶，其中88例為浸潤性癌，14例為乳腺導管原位癌。平均ADC值和腫瘤分級間存在顯著差異（p < 0.001）並呈負相關（Kendall's tau-b = -0.339；p < 0.001）。多元線性回歸顯示該關聯性獨立於其他預後因素。腋窩淋巴結陽性乳腺癌的平均ADC值顯著低於腋窩淋巴結陰性乳腺癌（p = 0.023）並具顯著負相關（r_pb = -0.226；p = 0.023），但該關聯性並非獨立於其他預後因素。ADC值在預測腫瘤侵襲性方面顯示良好的預測值，受試者工作特徵曲線下面積為0.717。
結論：較低ADC值與較高組織學分級密切相關。因此，ADC可被視為評估浸潤性乳腺癌的可靠預後參數。