Using the apparent diffusion coefficient histogram analysis to predict response to neoadjuvant chemotherapy in patients with breast cancer: comparison among three region of interest selection methods

BACKGROUND: The apparent diffusion coefficient (ADC) value using histogram analysis is helpful to predict responses to neoadjuvant chemotherapy (NAC) in breast cancer. However, the measurement method has not reached a consensus. This study was to assess the diagnostic performance of the ADC histogram analysis at predicting patient response prior to NAC in breast cancer patients using different region of interest (ROI) selection methods. METHODS: A total of 75 patients who underwent diffusion weighted imaging (DWI) prior to NAC were retrospectively enrolled from February 2017 to December 2019. Images were measured using small 2-dimensional (2D) ROI, large 2D ROI, and volume ROI methods. The measurement time and ROI size were recorded. Histopathologic responses were acquired using the Miller-Payne grading system after surgery. The inter- and intra-observer repeatability was analyzed and the ADC histogram values from the three ROI methods were compared. The efficacy of each method at predicting patient response prior to NAC was assessed using the area under the receiver operating characteristic curve (AUC) for the whole study population and subgroups according to molecular subtype. RESULTS: Among the 75 enrolled patients, 26 (34.67%) were responsive to NAC therapy. The ADC histogram values were significantly different among the three ROI methods (P≤0.038). Inter- and intra-observer repeatability of the large 2D ROI method and the volume ROI method was generally greater than that observed with the 2D ROI method. The 10% ADC value of the large 2D ROI method showed the greatest AUC (0.701) in the whole study population and in the luminal subgroup (AUC 0.804). The volume ROI method required significantly more time than the other two ROI methods (P<0.001). CONCLUSIONS: The small 2D ROI method is not appropriate for predicting response prior to NAC in breast cancer patients due to the poor repeatability. When choosing the ROI method and the histogram parameters for predicting response prior to NAC in breast cancer patients using ADC-derived histogram analysis, 10% of the large 2D ROI method is recommended, especially in luminal A subtype patients.