J Korean Soc Radiol.  2012 Sep;67(3):177-186. 10.3348/jksr.2012.67.3.177.

The Predictability for the Prognosis of Breast Cancer Using the Apparent Diffusion Coefficient Value of Diffusion-Weighted 3 T MRI and the Standardized Uptake Value of Positron Emission Tomography/CT: Assessment of Prognostic Factor

• Lim SJ
• Kim K
• Jang HY
• Hwang CM
• Kim DH
• Sohn JS
• Kim JS
• Lee JY

• KMID: 2097969
• DOI: http://doi.org/10.3348/jksr.2012.67.3.177

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).
CONCLUSION
pSUV and ADC values correlated with histologic grade, and tumor size. The pSUV/ADC value had a high accuracy for the diagnosis of breast cancer. Therefore, pSUV and ADC values provided additional information for predicting histologic grade and prognosis of breast cancer.

MeSH Terms

Breast
Breast Neoplasms
Carcinoma, Ductal
Carcinoma, Intraductal, Noninfiltrating
Diffusion
Electrons
Humans
Neoplasm Metastasis
Prognosis
Retrospective Studies

Figure

• 

  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

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