Keywords:
Pathology, Neoplasia, Cancer, Screening, Imaging sequences, Computer Applications-Detection, diagnosis, MR-Functional imaging, MR-Diffusion/Perfusion, MR, Oncology, Computer applications, Breast
Authors:
D. Tzias1, E. O'flynn2, S. allen1, R. Wilson3; 1london/UK, 2Sutton , Surrey/UK, 3Sutton/UK
DOI:
10.1594/ecr2013/C-0987
Purpose
Purpose
Invasive lobular cancer (ILC) accounts for 10-15% of all breast cancers. It is often difficult to diagnose mammographically as it tends to produce masses of relatively low radiographic opacity,
similar to normal fibroglandular breast tissue.
It has a unique histological growth pattern of non-cohesive cells that tend to infiltrate in thin strands only one cell in width (Indian filing) and may also be multifocal (more than one area of disease in one quadrant of the breast) or multicentric (more than one area of disease in more than one quadrant of the breast).
Due to the difficulty of accurate assessment on conventional imaging,
preoperative dynamic contrast enhanced (DCE)-MRI is advised in all cases of core-biopsy proven ILC if breast conservation surgery is considered. DCE-MRI is more accurate at delineating the true extent as well as identifying additional sites of disease in ILC however there are still opportunities for misdiagnosis as ILC can exhibit non-mass like morphology1 and delayed enhancement2.
The addition of diffusion weighted imaging (DWI) can improve the specificity of DCE-MRI from 74% to 85%3.
It provides different and complimentary information to DCE-MRI,
being sensitive to factors that affect the microscopic movement of water molecules over very small distances (<30µm).
Breast cancers demonstrate impeded diffusion because of a high cell density which results in a high signal intensity lesion on DWI and a corresponding low signal focus on the derived apparent diffusion coefficient (ADC) map.
ADC values differentiating malignant and benign breast lesions on DWI are well reported.
However ADC values for ILC have not been and so we document them and compare them with ADC values from invasive ductal carcinoma (IDC) to determine their utility in differentiating malignant from benign lesions.