Dynamic contrast-enhanced magnetic resonance imaging parameters combined with diffusion-weighted imaging for discriminating malignant lesions, molecular subtypes, and pathological grades in invasive ductal carcinoma patients

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters or diffusion-weighted imaging (DWI) findings provide prognostic information on breast cancer. However, the accuracy of a single MRI technique is unsatisfactory. This study intended to explore the combination of DWI and DCE-MRI parameters in discriminating molecular subtypes in invasive ductal carcinoma (IDC) patients. Eighty-two IDC patients who underwent breast DWI and DCE-MRI examinations were retrospectively analyzed. Eighty-six patients with benign masses were retrieved as benign controls. The combination of ADC value, Ktrans, Kep, Ve, and iAUC had a good ability to discriminate IDC patients (vs. benign controls) with an area under the curve (AUC) [95% confidence interval (CI)] of 0.961 (0.935-0.987). A nomogram-based prediction model with the above combination showed a good predictive value for IDC probability. The combination of ADC value, Ktrans, Kep, and iAUC also had a certain ability to discriminate pathological grade III (vs. I or II) [AUC (95% CI): 0.698 (0.572-0.825)] in IDC patients. Notably, ADC value (P=0.010) and Kep (P=0.043) differed in IDC patients with different molecular subtypes. Besides, ADC value was increased (P<0.001), but Ktrans (P=0.037) and Kep (P=0.004) were decreased in IDC patients with Lumina A (vs. other molecular subtypes). The combination of ADC value, Ktrans, Kep, had an acceptable ability to discriminate Luminal A (vs. other molecular subtypes) [AUC (95% CI): 0.845 (0.748-0.941)] in IDC patients. DWI combined with DCE-MRI parameters discriminates IDC from benign masses; it also identifies Luminal A and pathological grade III in IDC patients.