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Risk stratification of ductal carcinoma in situ using whole-lesion histogram analysis of the apparent diffusion coefficient

  • Kim, Jin You1, 2
  • Kim, Jin Joo1
  • Lee, Ji Won1
  • Lee, Nam Kyung1
  • Lee, Geewon1
  • Kang, Taewoo3
  • Park, Heesung3
  • Son, Yo Han4
  • Grimm, Robert5
  • 1 Pusan National University School of Medicine and Medical Research Institute, Department of Radiology, Pusan National University Hospital, 1-10, Ami-Dong, Seo-gu, Busan, 602-739, Republic of Korea , Busan (South Korea)
  • 2 Pusan National University School of Medicine, Medical Research Institute, Busan, Republic of Korea , Busan (South Korea)
  • 3 Pusan National University Hospital, Busan Cancer Center, Busan, Republic of Korea , Busan (South Korea)
  • 4 Siemens Healthineers, Seoul, Korea , Seoul (South Korea)
  • 5 MR Application Predevelopment, Siemens Healthineers, Erlangen, Germany , Erlangen (Germany)
Published Article
European Radiology
Publication Date
Aug 02, 2018
DOI: 10.1007/s00330-018-5666-x
Springer Nature


ObjectivesTo investigate the value of the whole-lesion histogram apparent diffusion coefficient (ADC) metrics for differentiating low-risk from non-low-risk ductal carcinoma in situ (DCIS).MethodsThe authors identified 93 women with pure DCIS who had undergone preoperative MR imaging and diffusion-weighted imaging from 2013 to 2016. Histogram analysis of pixel-based ADC data of the whole tumour volume was performed by two radiologists using a software tool. The results were compared between low-risk and non-low-risk DCIS. Associations between quantitative ADC metrics and low-risk DCIS were evaluated by receiver operating characteristics (ROC) curve and logistic regression analyses.ResultsIn whole-lesion histogram analysis, mean ADC and 5th, 50th and 95th percentiles of ADC were significantly different between low-risk and non-low-risk DCIS (1.522, 1.207, 1.536 and 1.854 × 10−3 mm2/s versus 1.270, 0.917, 1.261 and 1.657 × 10−3 mm2/s, respectively; p = .004, p = .003, p = .004 and p = .024, respectively). ROC curve analysis for differentiating low-risk DCIS revealed that 5th percentile ADC yielded the largest area under the curve (0.786) among the metrics of whole-lesion histogram, and the optimal cut-off point was 1.078 × 10−3 mm2/s (sensitivity 80%, specificity 75.9%, p = .001). Multivariate regression analysis revealed that a high 5th percentile of ADC (> 1.078× 10−3 mm2/s; odds ratio [OR] = 10.494, p = .016), small tumour size (≤ 2 cm; OR = 12.692, p = .008) and low Ki-67 status (< 14%; OR = 10.879, p = .046) were significantly associated with low-risk DCIS.ConclusionsAssessment with whole-lesion histogram analysis of the ADC could be helpful for identifying patients with low-risk DCIS.Key Points• Whole-lesion histogram ADC metrics could be helpful for differentiating low-risk from non-low-risk DCIS.• A high 5th percentile ADC was a significant factor associated with low-risk DCIS.• Risk stratification of DCIS is important for their management.

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