COMPARATIVE STUDY OF DWI VS DYNAMIC CONTRAST ENHANCED MRI IN DIAGNOSIS OF BREAST TUMORS KEEPING HISTOPATHOLOGY AS GOLD STANDARD

Abstract

Background: Breast cancer remains a leading cause of morbidity and mortality among women worldwide. Early and accurate detection plays a crucial role in improving treatment outcomes and survival rates. Imaging modalities such as Diffusion-Weighted Imaging (DWI) and Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) offer promising non-invasive diagnostic approaches. These methods provide valuable anatomical and functional information, particularly in cases where biopsy is limited by lesion size or location.

Objective: To assess and compare the diagnostic accuracy of DWI and DCE-MRI in differentiating between benign and malignant breast tumors, using histopathology as the gold standard.

Methods: This cross-sectional study was conducted at the Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, from September 2022 to August 2024. A total of 100 female patients aged 18–75 years were enrolled through purposive sampling after obtaining informed consent. All participants underwent breast MRI using a 1.5 Tesla machine, incorporating both DWI with b-values of 0 and 750 s/mm² and DCE-MRI. Time-Intensity Curves (TIC) were generated, and tumor classification was performed according to ACR BI-RADS. Imaging findings were compared with histopathological outcomes to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA).

Results: The mean age of patients with benign tumors was 39.76 ± 12.30 years, while for malignant tumors it was 44.62 ± 11.68 years. Histopathological evaluation confirmed 29% benign and 71% malignant tumors. DWI showed a sensitivity of 97.18%, specificity of 89.66%, PPV of 95.83%, NPV of 92.86%, and diagnostic accuracy of 95%. DCE-MRI demonstrated sensitivity of 97.18%, specificity of 86.21%, PPV of 94.52%, NPV of 92.59%, and diagnostic accuracy of 94%. Combining both modalities improved diagnostic accuracy to 97%.

Conclusion:DWI and DCE-MRI demonstrated high diagnostic performance in distinguishing breast tumor types. Combined use further enhances accuracy and may reduce the need for invasive procedures, especially in diagnostically challenging cases.