Role of Diffusion-Weighted Magnetic Resonance Imaging for Detection of Multifocality, Multicentricity and Contra Lateral Side in Newly Diagnosed Breast Cancer: Comparison with Combined Mammography and Whole-Breast Ultrasound and Histopathological Correlation

Abstract

Background: Diffusion-weighted MRI is fast, unenhanced modality that shows promise in identifying mammographically occult malignancy. it demonstrates breast malignancies based on reduced water diffusivity relative to normal tissue. This study aimed to compare the performance of (DW) MRI and combined mammography and (US) in detecting lesions and assessment of contralateral breast cancer in women. Methods: This prospective cross-sectional study included 150 female patients newly diagnosed with breast cancer. All patients underwent breast mammography, ultrasound and DWI breast MRI, all MRI examinations were performed using 1.5 tesla. Results: DWI demonstrated a higher sensitivity (93.9%) compared to Sono-MMG (85.9%), with both modalities achieving perfect specificity (100%) and positive predictive value (PPV) of 100%. The negative predictive value (NPV) was higher for DWI (89.5%) than for Sono-MMG (78.5%), In assessing tumors larger than 5 cm, DWI showed a sensitivity of 100%, significantly outperforming Sono-MMG's 48.8%, while both methods maintained 100% specificity and PPV. The NPV for DWI was also 100%, compared to 83.8% for Sono-MMG, regarding muscle invasion detection, DWI showed superior sensitivity at 100%, whereas Sono-MMG had a sensitivity of 33.3%. Conclusion: Our study suggest that DW MRI has the potential as a screening tool for breast cancer detection and as a complementary to sono-mammography in assessing breast cancer. Combining both DCE-MRI and DW-MRI is the ultimate technique for better lesion evaluation.