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Breast cancer is the most common malignant tumor among women.
The purpose of all diagnostic modalities in breast cancer is early detection and proper diagnosis, which has its major impact on further management and prognosis.
X-ray mammography is still considered the first examination tool in diagnosis of breast disease world wide.
The overlap in the mammographic appearance of benign and malignant lesions as well as dense breast tissue especially in young patients necessitates the presence of problem solving complementary studies.
Ultrasound (US) has been established as a complementary tool for mammography because of long experience with its use, accessibility, relatively low cost and the opportunity it affords for real time guidance of aspiration or needle biopsy. However, its operator dependence nature remains its main limitation.
The sensitivity of breast MRI for the detection of cancer is the greatest of all imaging techniques and when the findings of conventional imaging are inconclusive (i.e. BI-RADS 0), MRI can be used as a problem-solving modality, it is also better at identifying the true extent of cancer when multifocal disease or ductal carcinoma in situ is present. However its reported specificity is variable.
Recent developments in MR imaging technology have enabled the clinical application of DWI to the entire body, which has shown great promise for the detection and characterization of most tumor types. Through imaging of alterations in the microscopic motion of water molecules, DWI can yield novel quantitative and qualitative information reflecting cellular changes that can provide unique insights into tumor cellularity.
DWI is a safe, fast, non-contrast sequence that can be easily added to all MRI machines. DWI is still considered a promising tool that might improve the conventional MRI specificity. DWI can be easily added to the routine MRI examination of the breast with no significant lengthening of the examination time
The current study evaluated the role of DWI in differentiating between benign and malignant breast lesions diagnosed by mammography and US examination.
We conducted the study in Mattariya Teaching hospital. The study included 40 patients with 40 breast lesions. Cases were referred from oncology and surgery departments.Patients underwent mammographic or ultrasonographic examinations then all patients were referred for MRI examination with classification of their findings according to Breast imaging reporting and Data System. The findings of each modality were correlated with histopathological results.
In our study the sensitivity of DWI for mass lesions and ADC value was 85.2%, specificity was 84.6 %.
So use of DWI as a diagnostic tool can increase the specificity of breast MR imaging and can reduce the number of false-positive results and associated unnecessary biopsies. In addition, DWI can be performed without significantly increasing examination time
DWI can be used alone in combination with T2WI for cases in whom contrast agent could not be given (e.g. pregnancy, renal dysfunction and those who have sensitivity against contrast agent). Thus, it is recommended as a part of routine examination.