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Differentiation of fibroadenomas versus malignant breast tumors utilizing three-dimensional amide proton transfer weighted magnetic resonance imaging

  • Author Footnotes
    1 Nan Zhang and Jianyun Kang contributed equally to this work, they're co-first authors.
    Nan Zhang
    Footnotes
    1 Nan Zhang and Jianyun Kang contributed equally to this work, they're co-first authors.
    Affiliations
    Department of Radiology, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
    Search for articles by this author
  • Author Footnotes
    1 Nan Zhang and Jianyun Kang contributed equally to this work, they're co-first authors.
    Jianyun Kang
    Footnotes
    1 Nan Zhang and Jianyun Kang contributed equally to this work, they're co-first authors.
    Affiliations
    Department of Radiology, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
    Search for articles by this author
  • Huali Wang
    Affiliations
    Department of Pathology, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
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  • Ailian Liu
    Affiliations
    Department of Radiology, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
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  • Yanwei Miao
    Affiliations
    Department of Radiology, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
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  • Xiaolu Ma
    Affiliations
    Department of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
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  • Author Footnotes
    2 Lina Zhang and Qingwei Song contributed equally to this work, they're co-correspondence authors.
    Qingwei Song
    Correspondence
    Corresponding authors at: The First Affiliated Hospital of Dalian Medical University, Department of Radiology, Xigang District, Zhongshan Road, No.222, Dalian, PR China.
    Footnotes
    2 Lina Zhang and Qingwei Song contributed equally to this work, they're co-correspondence authors.
    Affiliations
    Department of Radiology, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
    Search for articles by this author
  • Author Footnotes
    2 Lina Zhang and Qingwei Song contributed equally to this work, they're co-correspondence authors.
    Lina Zhang
    Correspondence
    Corresponding authors at: The First Affiliated Hospital of Dalian Medical University, Department of Radiology, Xigang District, Zhongshan Road, No.222, Dalian, PR China.
    Footnotes
    2 Lina Zhang and Qingwei Song contributed equally to this work, they're co-correspondence authors.
    Affiliations
    Department of Radiology, First Affiliated Hospital of Dalian Medical University, No 222 zhongshan Road, Xigang district, Dalian, Liaoning 116011, PR China
    Search for articles by this author
  • Jiazheng Wang
    Affiliations
    MSC Clinical & Technical Solutions, Philips Healthcare, 16 Tianze Road, Beijing, PR China
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  • Zhiwei Shen
    Affiliations
    MSC Clinical & Technical Solutions, Philips Healthcare, 16 Tianze Road, Beijing, PR China
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  • Xiaofang Xu
    Affiliations
    MSC Clinical & Technical Solutions, Philips Healthcare, 16 Tianze Road, Beijing, PR China
    Search for articles by this author
  • Author Footnotes
    1 Nan Zhang and Jianyun Kang contributed equally to this work, they're co-first authors.
    2 Lina Zhang and Qingwei Song contributed equally to this work, they're co-correspondence authors.
Published:September 25, 2021DOI:https://doi.org/10.1016/j.clinimag.2021.09.002

      Highlights

      • APTw imaging can be used prospectively differentiating benign from malignant tumors.
      • APTw imaging yielded similar diagnosis performance in discriminating benign and malignant breast tumors when compared to the DCE and better than DWI imaging.
      • The APTw value showed a negative correlation with ER expression.

      Abstract

      Objective

      To explore the value of amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI) for differential diagnosis of fibroadenomas and malignant breast tumors.

      Materials and methods

      This prospective study enrolled 56 patients with suspected breast tumors and performed APTw imaging. Based on the histopathology results, patients were divided into group 1 with malignant breast tumors (n = 41) and group 2 with fibroadenomas (n = 15). The measured image parameters (APTw value, ADC value, type of Time of Intensity Curve, maximum tumor diameter in image) and the maximal diameter of the tumors measured from surgical resection were compared between the two groups, and the diagnostic performance based on these parameters was quantified with ROC curve. Spearman's correlation coefficient was used to analyze the association between APTw or ADC values and ER, PR, HER2, and Ki-67 expressions.

      Results

      The intraclass correlation coefficients (ICC = 0.87 and 0.91) indicated a good inter-observer agreement of the measured APTw values. APTw values of malignant lesions were significantly higher than those of fibroadenomas (3.21 ± 1.04% vs 1.50 ± 0.54%, p < 0.001). Area under the curve (AUC) obtained from APTw imaging, DWI, DCE, APTw imaging+DWI, APTw imaging+DWI, and APTw imaging+DWI + DCE was 0.959, 0.897, 0.976, 0.997, and 1 respectively. The APTw value showed a negative correlation with ER expression (r = −0.357).

      Conclusion

      APTw imaging yielded similar diagnosis performance in discriminating fibroadenomas and malignant breast tumors when compared to the DCE and better than DWI imaging, and provided supplement information on tumor cell activity to DWI images. The APTw value showed correlations with some prognostic factors for breast cancer.

      Keywords

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