On a fractional order calculus model in diffusion weighted breast imaging to differentiate between malignant and benign breast lesions detected on X-ray screening mammography

OBJECTIVE: To evaluate a fractional order calculus (FROC) model in diffusion weighted imaging to differentiate between malignant and benign breast lesions in breast cancer screening work-up using recently introduced parameters (β(FROC), D(FROC) and μ(FROC)). MATERIALS AND METHODS: This retrospective analysis within a prospective IRB-approved study included 51 participants (mean 58.4 years) after written informed consent. All patients had suspicious screening mammograms and indication for biopsy. Prior to biopsy, full diagnostic contrast-enhanced MRI examination was acquired including diffusion-weighted-imaging (DWI, b = 0,100,750,1500 s/mm(2)). Conventional apparent diffusion coefficient D(app) and FROC parameters (β(FROC), D(FROC) and μ(FROC)) as suggested further indicators of diffusivity components were measured in benign and malignant lesions. Receiver operating characteristics (ROC) were calculated to evaluate the diagnostic performance of the parameters. RESULTS: 29/51 patients histopathologically revealed malignant lesions. The analysis revealed an AUC for D(app) of 0.89 (95% CI 0.80–0.98). For FROC derived parameters, AUC was 0.75 (0.60–0.89) for D(FROC), 0.59 (0.43–0.75) for β(FROC) and 0.59 (0.42–0.77) for μ(FROC). Comparison of the AUC curves revealed a significantly higher AUC of D(app) compared to the FROC parameters D(FROC) (p = 0.009), β(FROC) (p = 0.003) and μ(FROC) (p = 0.001). CONCLUSION: In contrast to recent description in brain tumors, the apparent diffusion coefficient D(app) showed a significantly higher AUC than the recently proposed FROC parameters β(FROC), D(FROC) and μ(FROC) for differentiating between malignant and benign breast lesions. This might be related to the intrinsic high heterogeneity within breast tissue or to the lower maximal b-value used in our study.