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Original research article


A Clinical Approach to Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Chest Wall Invasion of Breast Tumors

Naziya Samreen1Christine Lee1Asha Bhatt1Jodi Carter2Tina Hieken3Kalie Adler1Shannon Zingula1Katrina N. Glazebrook1
1Departments of Radiology, 2Laboratory Medicine and Pathology, 3Surgery, Mayo Clinic, Rochester, MN, USA.
Date of Submission: 03-Dec-2018, Date of Acceptance: 15-Jan-2019, Date of Web Publication: 30-Apr-2019.
Corresponding Author:
Corresponding Author

Naziya Samreen

Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester 55905, MN, USA.
E-mail: samreen.naziya@gmail.com

Corresponding Author:
Corresponding Author

Naziya Samreen

Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester 55905, MN, USA.
E-mail: samreen.naziya@gmail.com

DOI: 10.25259/JCIS_97_18 Facebook Twitter Google Linkedin

ABSTRACT



Objective: The purpose of this study is to evaluate diffusion weighted magnetic rsonance imaging (MRI) acquisitions in delineating posterior extent of breast tumors and in predicting chest wall invasion prior to treatment. To our knowledge, there has not been any literature specifically evaluating the utility of diffusion‑weighted acquisitions in chest wall invasion of breast tumors.
Materials and Methods: A retrospective review of our breast imaging database for keywords “chest wall invasion” and “breast MRI” was performed over the last 14 years. Diffusion sequences, T1 sequences (pre and post contrast), and T2 sequences were evaluated. Apparent diffusion coefficient (ADC) values in tumor and chest wall were assessed. Imaging findings were correlated with surgical pathology.
Results: 23 patients met inclusion criteria. All 23 had loss of fat plane on T2 sequences. 22/23 had loss of fat plane on postcontrast T1 sequences. Pectoralis muscle enhancement was present in 19/23 (83%) tumors and chest wall enhancement was present 9/23 (39%) tumors. Qualitative restricted diffusion within the pectoralis muscle was present in 18/23 (71%) tumors and in the chest wall was present in 8/23 (35%) tumors. Mean ADC values were 1.15 s/mm2 in the tumor and 1.29 s/mm2 in the chest wall. Sensitivity, specificity, positive predictive value and negative predictive value were 100%, 36%, 63%, and 100% for chest wall enhancement respectively and 69%, 36%, 61%, and 80% for chest wall diffusion‑weighted imaging restriction respectively.
Conclusion: Diffusion weighted sequences can be helpful in characterizing chest wall invasion of breast tumors.
Keywords: Breast cancer, breast tumors, chest wall invasion, diffusion weighted magnetic resonance imaging

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