Role of diffusion-weighted imaging in prediction of nipple-areolar complex invasion by breast cancer

The aim of this work The aim of this work was to estimate the role of diffusion-weighted imaging (DWI) in predicting malignant invasion of the nipple-areolar complex (NAC) by underlying breast cancer. Material and methods This prospective study included 70 female patients with breast cancer with a mean age of 45.8 years (range: 28–68). DWI of the breast was done for all patients. Apparent diffusion coefficient (ADC) maps were automatically constructed. The mean ADC values of NAC were independently measured by two observers who are experts in breast imaging and correlated with the results of histopathological examinations. Results Both observers found a significantly lower ADC value of malignant NAC invasion (n = 18) when compared with free NAC (n = 52), with mean ADC value for malignant NAC invasion was 0.86 ± 0.35 × 10−3 mm2/s and 0.84 ± 0.08 × 10−3 mm2/s for observer one and two respectively versus mean ADC value of 1.34 ± 0.25 × 10−3 mm2/s and 1.4 ± 0.26 × 10−3 mm2/s for free NAC by observer one and two respectively (P-value =0.001). Observer one found that a cutoff ADC value of 1.05 × 0−3 mm2/s can predict malignant NAC invasion with 0.975 AUC, 92.8% accuracy, 94.4% sensitivity, and 92.3% specificity. Observer two found that a cutoff ADC value of 0.95 × 10−3 mm2/s can predict malignant NAC invasion with 0.992 AUC, 95.7% accuracy, 88.9% sensitivity, and 98.1% specificity. Conclusion DWI can predict malignant NAC invasion in patients with breast cancer.