Two Different Methods of Region-of-Interest Placement for Differentiation of Benign and Malignant Breast Lesions by Apparent Diffusion Coefficient Value

Purpose: We aimed to investigate the influence of different methods of region-of-interest (ROI) placement on apparent diffusion coefficient (ADC) values in breast tumours and their accuracy in differentiating benign versus malignant tumors in mass and nonmass lesions. Methods and Materials: In this prospective study, 79 patients with 98 breast lesions, from 2015 until 2017, were investigated by 1.5-T breast MRI. Histopathology evaluation were done for all malignant lesions and most of the benign ones. ADC values were measured in normal breast tissue and by two ways of ROI placement in the breast lesions (mass and non-mass): 1- ROI covering the whole lesion, 2- ROI in the highest part (most restricted area) of the lesion in DWI images. The accuracy of these two approaches were compared. Results: The age range was 17-68 years with mean age 43.3 ± 9.9 years. 49% of the lesions were benign and 51% of tumors were malignant. Our results revealed that the measured ADC values in normal breast tissue were higher than breast lesions (P≤0.01). Appropriate cut off determination in non-mass was not valid by both methods, but in mass in the first way was 1.45×10 -³mm²/s and in the most restricted part was 1.16×10-³ mm²/s. ADC values differed significantly between the two ways of ROI placement in mass lesions (P<.001). Most restricted part ADC showed the best diagnostic performance in mass lesions with area under curve 0.88 versus 0.82. Conclusion: ROI placement has significant impact on the meseaured ADC values of breast lesions and ROIs in most restricted parts were more accurate than whole-lesion ROIs. Cut-off values differed significantly based on the methods of measurement.