Diffusion-Weighted Imaging Helps Detect Breast Cancer in Dense Breasts

Study results presented at the Radiological Society of North America (RSNA) 2021 Annual Meeting suggest that diffusion-weighted imaging was a sensitive and effective screening method for breast cancer detection in asymptomatic women with dense breasts. 

“Mammography has low sensitivity in dense breasts and needs to be supplemented with another screening method for women with dense breasts,” the authors wrote. “Diffusion-weighted imaging may be useful as a safe and effective screening tool for the supplementation of mammography in women with dense breast tissues.”

The results were presented by Hee Jeong Kim, M.D., breast cancer center at Asan Medical Center in Seoul, Korea.

In the study, the researchers assessed the diagnostic performance of diffusion-weighted imaging for breast cancer detection in asymptomatic women with dense breast tissue on mammography. The researchers also compared the diagnostic performance of mammography, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging.

From August 2018 to January 2019, the researchers retrospectively reviewed 297 consecutive asymptomatic women, mean age of 51 years, with dense breast tissue on mammography who underwent breast MRI including diffusion-weighted imaging and DCE protocols and mammography. Three readers independently reviewed the lesion visibility and level of suspicion on each imaging modality. Histopathologic features of the tumors on surgical specimen served as the standard of reference.

A total of 233 breast cancers were identified in 230 women, benign lesions were identified in 11 women and normal breasts were identified in 56 women. Of the 233 cancers, 15% presented as ductal carcinoma in situ, 12% as microinvasive ductal carcinoma and 73% as invasive carcinoma. The overall sensitivity was 61.4% in mammography, 79.4% in diffusion-weighted imaging, 86.3% in DCE-MRI and 91.8% in the combination of mammography and diffusion-weighted imaging. The sensitivities for noninvasive cancer in mammography, diffusion-weighted imaging, DCE-MRI, and the combination of mammography and diffusion-weighted imaging were 73%, 68.3%, 74.6% and 92.1%, while the sensitivities for invasive cancer smaller than 20 mm were 51.9%, 81.5%, 88.9% and 89.6%, and the sensitivities for invasive cancer larger than 20 mm were 77.1%, 91.4%, 97.1% and 100%, respectively. 

When diagnostic performance was assessed by using areas under the receiver operating characteristic curves, diffusion-weighted imaging was superior to mammography (P < .001) and comparable to DCE-MRI when combined with mammography (P = .05).

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