Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI

A trial of the ECOG-ACRIN Cancer Research group (A6702)

Habib Rahbar, Zheng Zhang, Thomas L. Chenevert, Justin Romanoff, Averi E. Kitsch, Lucy G. Hanna, Sara M. Harvey, Linda Moy, Wendy B. DeMartini, Basak Dogan, Wei T. Yang, Lilian C. Wang, Bonnie N. Joe, Karen Oh, Colleen H. Neal, Elizabeth S. McDonald, Mitchell D. Schnall, Constance D. Lehman, Christopher E. Comstock, Savannah C. Partridge

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: Conventional breast MRI is highly sensitive for cancer detection but prompts some false positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion-weighted imaging (DWI) can decrease MRI false positives. Experimental Design: A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. Results: Of 107 women enrolled, 67 patients (median age 49, range 24–75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. Sixty-seven of 81 lesions were BI-RADS 4 (n ¼ 63) or 5 (n ¼ 4) and recommended for biopsy. Malignancies exhibited lower mean in centrally measured ADCs (mm 2 /s) than benign lesions [1.21 10 3 vs.1.47 10 3 ; P < 0.0001; area under ROC curve ¼ 0.75; 95% confidence interval (CI) 0.65–0.84]. In centralized analysis, application of an ADC threshold (1.53 10 3 mm 2 /s) lowered the biopsy rate by 20.9% (14/67; 95% CI, 11.2%–31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68 10 3 mm 2 /s) to site-measured ADCs reduced the biopsy rate by 26.2% (16/61) but missed three cancers. Conclusions: DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.

Original languageEnglish (US)
Pages (from-to)1756-1765
Number of pages10
JournalClinical Cancer Research
Volume25
Issue number6
DOIs
StatePublished - Jan 1 2019

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Breast
Biopsy
Research
Neoplasms
ROC Curve
Confidence Intervals
Multicenter Studies
Area Under Curve
Research Design
Prospective Studies

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI : A trial of the ECOG-ACRIN Cancer Research group (A6702). / Rahbar, Habib; Zhang, Zheng; Chenevert, Thomas L.; Romanoff, Justin; Kitsch, Averi E.; Hanna, Lucy G.; Harvey, Sara M.; Moy, Linda; DeMartini, Wendy B.; Dogan, Basak; Yang, Wei T.; Wang, Lilian C.; Joe, Bonnie N.; Oh, Karen; Neal, Colleen H.; McDonald, Elizabeth S.; Schnall, Mitchell D.; Lehman, Constance D.; Comstock, Christopher E.; Partridge, Savannah C.

In: Clinical Cancer Research, Vol. 25, No. 6, 01.01.2019, p. 1756-1765.

Research output: Contribution to journalArticle

Rahbar, H, Zhang, Z, Chenevert, TL, Romanoff, J, Kitsch, AE, Hanna, LG, Harvey, SM, Moy, L, DeMartini, WB, Dogan, B, Yang, WT, Wang, LC, Joe, BN, Oh, K, Neal, CH, McDonald, ES, Schnall, MD, Lehman, CD, Comstock, CE & Partridge, SC 2019, 'Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A trial of the ECOG-ACRIN Cancer Research group (A6702)', Clinical Cancer Research, vol. 25, no. 6, pp. 1756-1765. https://doi.org/10.1158/1078-0432.CCR-18-2967
Rahbar, Habib ; Zhang, Zheng ; Chenevert, Thomas L. ; Romanoff, Justin ; Kitsch, Averi E. ; Hanna, Lucy G. ; Harvey, Sara M. ; Moy, Linda ; DeMartini, Wendy B. ; Dogan, Basak ; Yang, Wei T. ; Wang, Lilian C. ; Joe, Bonnie N. ; Oh, Karen ; Neal, Colleen H. ; McDonald, Elizabeth S. ; Schnall, Mitchell D. ; Lehman, Constance D. ; Comstock, Christopher E. ; Partridge, Savannah C. / Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI : A trial of the ECOG-ACRIN Cancer Research group (A6702). In: Clinical Cancer Research. 2019 ; Vol. 25, No. 6. pp. 1756-1765.
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abstract = "Purpose: Conventional breast MRI is highly sensitive for cancer detection but prompts some false positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion-weighted imaging (DWI) can decrease MRI false positives. Experimental Design: A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. Results: Of 107 women enrolled, 67 patients (median age 49, range 24–75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. Sixty-seven of 81 lesions were BI-RADS 4 (n ¼ 63) or 5 (n ¼ 4) and recommended for biopsy. Malignancies exhibited lower mean in centrally measured ADCs (mm 2 /s) than benign lesions [1.21 10 3 vs.1.47 10 3 ; P < 0.0001; area under ROC curve ¼ 0.75; 95{\%} confidence interval (CI) 0.65–0.84]. In centralized analysis, application of an ADC threshold (1.53 10 3 mm 2 /s) lowered the biopsy rate by 20.9{\%} (14/67; 95{\%} CI, 11.2{\%}–31.2{\%}) without affecting sensitivity. Application of a more conservative threshold (1.68 10 3 mm 2 /s) to site-measured ADCs reduced the biopsy rate by 26.2{\%} (16/61) but missed three cancers. Conclusions: DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.",
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T1 - Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI

T2 - A trial of the ECOG-ACRIN Cancer Research group (A6702)

AU - Rahbar, Habib

AU - Zhang, Zheng

AU - Chenevert, Thomas L.

AU - Romanoff, Justin

AU - Kitsch, Averi E.

AU - Hanna, Lucy G.

AU - Harvey, Sara M.

AU - Moy, Linda

AU - DeMartini, Wendy B.

AU - Dogan, Basak

AU - Yang, Wei T.

AU - Wang, Lilian C.

AU - Joe, Bonnie N.

AU - Oh, Karen

AU - Neal, Colleen H.

AU - McDonald, Elizabeth S.

AU - Schnall, Mitchell D.

AU - Lehman, Constance D.

AU - Comstock, Christopher E.

AU - Partridge, Savannah C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Conventional breast MRI is highly sensitive for cancer detection but prompts some false positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion-weighted imaging (DWI) can decrease MRI false positives. Experimental Design: A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. Results: Of 107 women enrolled, 67 patients (median age 49, range 24–75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. Sixty-seven of 81 lesions were BI-RADS 4 (n ¼ 63) or 5 (n ¼ 4) and recommended for biopsy. Malignancies exhibited lower mean in centrally measured ADCs (mm 2 /s) than benign lesions [1.21 10 3 vs.1.47 10 3 ; P < 0.0001; area under ROC curve ¼ 0.75; 95% confidence interval (CI) 0.65–0.84]. In centralized analysis, application of an ADC threshold (1.53 10 3 mm 2 /s) lowered the biopsy rate by 20.9% (14/67; 95% CI, 11.2%–31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68 10 3 mm 2 /s) to site-measured ADCs reduced the biopsy rate by 26.2% (16/61) but missed three cancers. Conclusions: DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.

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