Intravoxel incoherent motion magnetic resonance imaging for breast cancer: A comparison with benign lesions and evaluation of heterogeneity in different tumor regions with prognostic factors and molecular classification

The objective of the present study was to compare the differentiation between breast cancer and benign breast lesions and study regional distribution characteristics in various subtypes of breast cancer using intravoxel incoherent motion (IVIM) parameters. This retrospective study involved 119 patients with breast cancer and 22 patients with benign breast lesions, who underwent 3.0T breast magnetic resonance imaging examinations. The apparent diffusion coefficient (ADC) and IVIM parameters (slow ADC, fast ADC and fraction of fast ADC) were obtained from patients with breast cancer and benign lesions using diffusion-weighted imaging (DWI) with b-values of 0, 50, 100, 150, 200, 400, 500, 1,000 and 1,500 sec/mm(2). Compared with patients with benign breast lesions, patients with breast cancer exhibited decreased ADC (P<0.001), slow ADC (P<0.001) and fast ADC (P<0.001) values, and higher fraction of fast ADC (P<0.001) values. Tumors with metastatic axillary lymph nodes demonstrated increased fraction of fast ADC values (P<0.001) and decreased slow ADC values (P<0.001) compared with tumors without metastatic axillary lymph nodes. The Fast ADC values of tumor tissues in estrogen receptor (ER) and progesterone receptor (PR) negative groups were higher than in positive groups (P<0.001), and the slow ADC values of tumor tissues were lower in ER and PR negative groups than positive groups (P<0.001). Luminal B (HER2- negative) tumor (P<0.001) and peritumor (P<0.001) tissues exhibited decreased fraction of fast ADC values, in comparison with other subtypes. Triple-negative breast cancer (TNBC) tumor tissue exhibited increased fast ADC (P<0.001) and fraction of fast ADC values (P<0.001), and decreased slow ADC values (P<0.001), when compared with other subtypes. The TNBC tumor edge tissues had increased fraction of fast ADC values compared with other subtypes (P<0.01) and TNBC tumor tissues (P<0.05). Therefore, the IVIM parameters of tumor, tumor edge and peritumor tissues in various subtypes of breast cancer may be useful for differentiation of breast cancer subtypes and to assess the invasive extent of the tumors.