“DIFFERENTIATING BENIGN FROM MALIGNANT BREAST LESIONS- CLINICAL, HISTOPATHOLOGICAL AND IMAGING CORRELATION”
Authors: REVIN REVIN , Singh Priya 
Published: August 2022

Introduction: Breast cancer is the second most common cancer in Indian women. Breast cancer is a
signicant cause of worldwide morbidity and mortality. Mammography and ultrasound are used as the
rst line of investigation for the early detection and localization of breast tumors. Mammography has high sensitivity in case of
patients with fatty parenchyma however low sensitivity in case of patients with dense breasts, implants, and post-surgical scar,
thus breast MRI with higher sensitivity and specicity due to its ability to depict excellent soft-tissue contrast has become
increasingly important in the detection of breast cancer. DCE-MRI has improved specicity in characterizing breast lesions by
analysis of time-intensity curves. Diffusion-weighted imaging can improve the sensitivity and specicity of MRI in the
evaluation of breast lesions by calculating the ADC values a quantitative measure that is a useful tool for tumor detection and
differentiating between benign and malignant breast lesions. To evaluate the role of diffusion-weighted MRI andObjective:
dynamic contrast-enhanced MRI in differentiating benign from malignant breast lesions and to compare the ndings of
diffusion-weighted MRI and dynamic enhanced MRI with histopathological or FNAC ndings. A totalMaterial And Methods:
of 30 patients with palpable breast lumps with either positive or negative ndings on mammography and ultrasound were
included in this study. All patients included in this study rst underwent lm-screen mammography. Ultrasonography was done
with convex and linear probes. This was followed by MRI. T1W axial, T2W axial, SPAIR/ Fat Saturated T2 weighted axial images
were acquired in appropriate imaging planes. Diffusion-weighted images were obtained using b values of 0 and 1000 and
ADC values were calculated. Dynamic contrast-enhanced MR was performed using fat-suppressed 3D T1 weighted images
after injection of gadolinium and time-intensity curves were generated. A single precontrast scan was followed by 4 post-
contrast scans which were obtained for a total duration of 4 min 24 seconds. Findings of the MRI (Diffusion-weighted and
dynamic contrast enhancement) were analyzed and correlated with histopathological and FNAC ndings to evaluate their use
as a diagnostic modality. A total of 30 female patients presenting with palpable breast lumps were included in theResults:
study. Out of 30 patients, 20 cases were malignant (66.67%) and 10 cases were benign (33.3%). Fibroadenoma accounted for a
majority of benign lesions (4 out of 10 benign lesions) while IDC accounted for the majority of malignant lesions (15 out of 20
malignant lesions). Dynamic CE-MR is a reliable tool for differentiating between benign and malignant lesions based on
kinetic curves. 7 out of 10 benign lesions showed a type I curve while the rest showed a type II curve while the majority (15/20) of
malignant lesions showed a type III curve. 8 out of 10 benign breast lesions did not show restricted diffusion on DWI while all
malignant lesions showed restricted diffusion on DWI. In our study, the mean ADC value for benign lesions was 1.59 x 10 mm/s
while the mean ADC value for malignant lesions was 0.88 x 10 mm/s. Using the ROC curve, the cut-off value of ADC was
calculated to be 1.19 x 10 mm/s which gives sensitivity and specicity of 95% and 90% respectively. The individual sensitivity for
DCE-MRI and DWI was calculated to be 95% and 95% while the individual specicity for DCE-MRI and DWI was calculated to
be 70% and 90% respectively. After a combined analysis of DCE-MRI and DWI using a positive result from any of the two
techniques as malignancy, the sensitivity and specicity were 95% and 80% respectively.